Financing healthcare is one of the main concerns of patients. Therefore, special attention must be paid to the financial aspect of cross-border patient movements, and the dedication of a separate chapter to these issues aims to emphasise their utmost importance in patients’ decisions. In this chapter, the main question to be answered is how cross-border medical treatments can be financed based on the healthcare entitlements of the patients in the Member State of affiliation.

When a patient receives healthcare in his/her ‘normal setting ’, in the Member State where he/she resides, and is familiar with the healthcare system and aware of the basic functioning of that system, he/she is more or less confident about when, how much and under what procedure he/she may expect to pay for healthcare. However, healthcare financing structures, as well as healthcare systems in general, vary greatly between the various Member States of the Union. Consequently, if the patient obtains healthcare abroad, the question of financing instantly arises. At the same time, the level of medical costs and especially cost-sharing arrangements can motivate patients to obtain healthcare in another country where the prices imposed on patients are more beneficial.

There are numerous methods of financing medical costs which might play a role in cross-border situations. Below, the following such methods are further scrutinised: out-of-pocket payments, payments through specialised insurance for travelling purposes and payments through healthcare schemes.

Out-of-pocket payments should be understood as those situations where the patient uses his/her own financial means to pay for healthcare services abroad without the prospect of reimbursement. This usually is the case if the patient lacks healthcare coverage within a statutory system or intends to ‘buy’ a medical treatment which is not included in the benefit basket provided for by the competent Member State (e.g. dental treatments, cosmetic surgical interventions). These patients are certainly free to receive the treatment of their choice in the Member State of their choice if the treatment requested is available in that country. Since this healthcare service consumption is independent from the social security coverage, neither the Coordination Regulations, nor the social security provisions of the Patient Mobility Directive (PMD) apply.