Patient mobility, changing territoriality and scale in the EU’s internal market

Case law on cross-border patient mobility of the Court of Justice of the European Union (CJEU) is part of a larger process of liberalization of cross-border healthcare in the EU’s internal market. It led to discussions about the end of territoriality in healthcare. If narrowly understood as territorial sovereignty, the internal market resulted in the end of territoriality in healthcare. However, the CJEU case law and its codification in the Patients’ Rights Directive (PRD) have also resulted in the creation of a new EU territory in which EU citizens have the right to cross-border healthcare under certain conditions. Furthermore, Member States have up-scaled territorial control of the access of cross-border healthcare and its reimbursement to the European level through the restricted codification of case law in the PRD. In addition, Member States have maintained territorial control of their healthcare systems by the way they have implemented the case law and the PRD, as demonstrated here by the Dutch and Belgian cases, founding members with considerable experience with cross-border healthcare. Thus, territoriality as a strategy of control is still alive in publicly insured healthcare, foremost at the national scale, as is also reflected by the limited centrifugal tendencies among potentially mobile patients and border regions.