D5.4 Policy report proposing a new system for patients' mobility across Europe

In 2023, the latest year for which data is available, over 20.0000 requests for cross-border treatment were received for 86.5 million EUR in reimbursements (EUROPEAN COMMISSION Directorate-General for Health and Food Safety, 2025).Most of the mobility is driven by patients’ aspiration to get better/closer/cheaper health care in a foreign country. Such mobility is highly regulated, it may create problems and extra costs in Member States (MS), since unless the numbers of patients that give up care in their MS to go abroad are known beforehand, it will replicate costs for health care (spare capacity in the origin country and extra cost to pay for mobility). This report moves from this fact to study under which conditions patients’ mobility may be instead welfare improving.We show that patients’ mobility has little impact on reducing quality gaps and in some cases, it may also have non-desirable effects, as it may reduce quality in the region where it is already lower. Where some positive effects exist, they are often obtained in a context where such mobility is regulated. In this respect the present legislation and limits to patients’ mobility make sense on economic grounds, especially when the latter is motivated by “quality” issues.The report suggests possible areas, where instead patients’ mobility (originating from MS rather than patients) may instead be beneficial. We argue that capacity management could be enhanced at EU level through patients’ mobility. In this report we have identified at least two interesting areas, namely supply-driven excess capacity, i.e. when health care provision requires a fixed capacity that cannot be tailored to demand, and demand-driven capacity, which derives from unexpected peaks in the demand of some specific services. We propose prices schemes for both types of mobility, which could be adapted to different objectives (from fairness to solidarity) and discuss, whether and under which conditions this type of mobility is compatible with the present EU legislation. At present there does not seem to be a systematic use of such mobility and we propose a more proactive role of the EU by, for example, setting registry for such capacity in excess. While the present legislation on patients’ mobility could accommodate for a systematic use of such instrument, the agreements across MS require the knowledge of where there are an excess capacity and an excess demand. The final area we have analysed, which could benefit from patients’ mobility, is the enhancement of research and treatments centres for orphan diseases. In this case the EU is trying to pursue an interesting strategy that may allow to balance patients’ aspirations to be treated as close to home as possible with the need of avoiding replications in sunk investments. We show that EU financed European Reference Networks (ERNs) combined with patients’ mobility may provide an innovative way tackle this problem, provided their implementation is supported by a good governance.