ESA closes infringement proceedings against Norway over reimbursement of cross-border healthcare costs

The EFTA Surveillance Authority (ESA) has decided to close a complaint case arising from Norway's failure to comply with EEA rules on patients' rights. The closure follows dialogue with Norway and subsequent changes to national legislation and administrative practice.

In March 2020, ESA received a complaint against Norway alleging that national legislation and administrative practices relating to the reimbursement of costs for cross-border healthcare were in breach of EEA law, in particular the Patients' Rights Directive.
Based on the complaint and following dialogue with national authorities, ESA decided to open a formal infringement procedure against Norway by sending a letter of formal notice in December 2022 . This was followed up by a reasoned opinion issued in July 2023.
The Patients' Rights Directive establishes a system in which patients are free to choose a healthcare provider anywhere in the EEA, and then receive reimbursement for such healthcare under the conditions set out in the directive. The costs are to be reimbursed to the patient, up to the level of the costs that would be covered for treatment in the home country. In Norway, however, only 80% of these costs were reimbursed to the patient. This practice was rooted in a calculation method applied to reimbursements between Norway's four regional health authorities. ESA maintained that the same method could not be applied to the reimbursement of costs owed directly to patients under the directive.
In addition, ESA argued that Norway did not give patients enough time to submit their claims. It found a six-month deadline starting on the first day of treatment to be unreasonable considering the time that healthcare providers may take to send invoices. ESA also challenged certain translation requirements.
Following a thorough assessment, ESA finds that Norway has amended its national legislation and/or administrative practices to the extent that it is now compliant with EEA law. ESA has accordingly decided to close the case. However, following breaches of EEA laws, the State is required to remedy any harm caused to people and businesses due to the infringement.

ESA's decision is available here.

Furthermore, ESA continues to pursue a separate case against Norway in the area of patients' rights, regarding restrictions on access to hospital treatment abroad. That case is currently pending before the EFTA Court.

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