| Verified against primary record | |
| Pattern in official data | Cross-border healthcare concerns mostly neighbouring countries[1] |
|---|---|
| Scale under the Directive | About 200,000 patients a year, under 0.05 per cent of EU citizens[2] |
| Records read | Commission data and audit report, 30 September 2026 |
| Independently reported | |
| Legal definition | None; arrangements are bilateral agreements and cooperation groupings[3] |
| Bands apply only to the rows beneath them. The figures describe activity recorded under the Directive and exclude privately funded travel. No provider-supplied figures are used. | |
Cross-border healthcare for border communities describes the use of health services on the other side of a nearby national border by people who live close to it. No legal definition of the category exists: cross-border healthcare itself is defined in European Union law, but border-zone arrangements are created by bilateral framework agreements and territorial cooperation groupings rather than by statute.[3]
The pattern in official data
Commission data collected under Directive 2011/24/EU states plainly that cross-border healthcare concerns mostly neighbouring countries. For reference year 2022 the busiest flows of patients requiring prior authorisation were from Slovakia to Czechia and from Luxembourg to Germany, and the busiest flows not subject to prior authorisation were from France to Spain, Italy and Belgium, from Denmark to Germany, and from Poland to Czechia.[1]
A later trend report covering 2021 to 2023 finds the same shape, recording that most countries treating more than 100 cross-border patients share a border with Germany and Luxembourg, the two states receiving the most prior authorisation requests in that period.[4] That report also notes a data limitation: several countries either lack access to all the information requested or cannot distinguish requests made under the Directive from those made under the social security coordination rules.[4]
The European Court of Auditors reached the same conclusion about geography and put the scale in context, reporting that the majority of patient mobility has been between neighbouring member states and that approximately 200,000 patients a year make use of the systems put in place under the Directive, representing less than 0.05 per cent of European Union citizens.[2] The same report identifies 423 European Union-funded projects supporting cross-border collaboration initiatives between 2007 and 2017, and notes that such cooperative arrangements often develop without the Commission’s involvement.[2]
How arrangements are built
Seven zones of organised access to cross-border healthcare were created along the Franco-Belgian border between 2008 and 2015, under a Franco-Belgian framework agreement, defining a cross-border living space in which hospitals and other medical or social centres agree to collaborate.[3] A Commission platform entry states that in 2015 some 20,000 French and Belgian patients received treatment on either side of that border under those arrangements.[5]
A single institution can also be shared. The Cerdanya cross-border hospital in Puigcerda, in the Pyrenees, opened in 2014 and is managed as a European Grouping of Territorial Cooperation. The Commission reports that between 20 and 30 per cent of its patients are French, that 40 per cent of its deliveries involve French mothers, and that it records around 44,000 consultations, 6,000 hospitalisations and 28,000 emergency visits annually.[6]
Related terms
Cross-border cooperation and territorial cooperation are the policy terms under which these arrangements are funded. They describe routine use of the nearest suitable hospital, which happens to be in another country, and are distinct from travel undertaken to seek out a particular provider abroad.
See also
- Cross-border healthcare, the legal category and its EU definition
- Government-funded treatment abroad, the two routes under which this activity is recorded
- Domestic medical tourism, the comparison case of travel within one country
- Medical travel and waiting lists, a separate reason for crossing a border for care
References
- European Commission, Directorate-General for Health and Food Safety. Member State data on cross-border patient healthcare following Directive 2011/24/EU. Reference year 2022, final version January 2024. Verified against primary record: official statistics publication opened and read. Retrieved 30 September 2026.
- European Court of Auditors. EU actions for cross-border healthcare: significant ambitions but improved management required. Special Report 7/2019. Verified against primary record: audit report opened and read. Retrieved 30 September 2026.
- Leloup F. Research for REGI Committee: Cross-border cooperation in healthcare. European Parliament, Policy Department for Structural and Cohesion Policies, October 2021. Independently reported: commissioned study. Retrieved 30 September 2026.
- European Commission, Directorate-General for Health and Food Safety. Member State data on cross-border patient healthcare following Directive 2011/24/EU: Trend Report, reference years 2021 to 2023. Final version September 2025. Verified against primary record: official statistics publication opened and read. Retrieved 30 September 2026.
- Vandeweghe K. ZOASTs: seven zones of organised access to cross-border healthcare. European Commission Futurium platform, 10 January 2018. Independently reported: institutional platform entry. Retrieved 30 September 2026.
- European Commission, Regional Policy. The Cerdanya Cross-Border Hospital: Healthcare Beyond Borders. 20 February 2026. Independently reported: institutional account. Retrieved 30 September 2026.
Sourcing note: the Commission data publications and the Court of Auditors report were opened and read on 30 September 2026. The parliamentary study and the two institutional accounts are independently reported. All figures describe activity recorded under Directive 2011/24/EU or under named local arrangements, and exclude privately funded travel, so they do not measure cross-border care as a whole. The Commission’s own trend report records that several countries cannot distinguish requests under the Directive from those under the social security coordination rules, which limits the precision of any total.