ICD carrier and living in the border region? If so, the attending cardiologist may be located in a neighbouring country. It follows from European law that EU citizens have the possibility to receive care across borders. Yet this provision of care does not appear to be widely accepted. For example, CBR does not accept certificates from cardiologists based abroad. Such actions may be considered contrary to applicable European law.
Persons with an Implantable Cardioverter Defibrilator (ICD) must report to the CBR to prove their fitness to participate in traffic. This requires an endorsement from a cardiologist. If the cardiologist is based abroad, this endorsement will not be accepted. Argument raised? There is no way to check whether the foreign doctor meets Dutch requirements.
Such a justification cannot be accepted in the light of applicable European law. It follows from the landmark Kohll judgment[1] that healthcare in the EU is also covered by the free movement of services. As such, restrictions on that free movement are in principle not allowed, but can be justified. Clearly, in the present case, there is an obstacle to the free movement of services. An EU citizen cannot go to his regular cardiologist in the neighbouring country for the medical examination, but must instead use the services of a Netherlands-based and BIG-registered cardiologist.
Is this obstacle justified? In light of the Kohll case, this question should be answered in the negative. The case revolved around whether it was permissible for social security institutions to require authorisation before individuals could receive care abroad. Luxembourg, the home country in the case, argued that services abroad could only be reimbursed after authorisation from the social security institution in the home country. The underlying reason was related to public health protection: the authorisation served to guarantee the quality of medical services in the neighbouring country.
The EU Court of Justice gave short shrift to this line of argument. Indeed, the conditions for access to and practice of the medical profession are harmonised at the European level. Indeed, such conditions are laid down in the Professional Qualifications Directive,[2] from which it follows, according to the Court, that doctors in all EU Member States offer equivalent guarantees to nationally established doctors. Thus, quality assurance of medical services from other Member States must be regarded as an unjustified restriction on the free movement of services.
CBR’s actions should also be regarded as quality assurance. In the light of the Kohll case, it should be concluded that this is contrary to applicable European legislation. However, the solution is simple: accept the foreign cardiologist’s statement. If the CBR wants to confirm that the foreign cardiologist is trained to European standards, it can appeal to the available doctors’ registers of neighbouring countries.
[1] Case C-158/96 Kohll, EU:C:1998:171.
[2] Directive 2005/36/EC as amended by Directive 2013/55/EU.