Lightning or Lightning Bug: The Role of the Language Gap and the Access to Proper Information on Entitlements in Cross-border Patient Mobility

in European Journal of Health Law
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The language barrier and the lack of reliable information were identified as major practical obstacles of European patient mobility. Patients are highly concerned about the ability to communicate with their doctors when obtaining healthcare in a country where they do not speak the local language, as well as they find it complicated to gather all the necessary information about an unfamiliar healthcare system or about their cross-border healthcare entitlements conferred on them by the Union legislation. In a multilingual and patient-friendly European Union these issues must be tackled in order to ensure effective healthcare and to enforce patients’ right to cross-border healthcare. This article investigates the current legal tools within the European Union on language gap in patient-provider communication and access to information on cross-border healthcare entitlements. Moreover, it offers some possible solutions for the future.




Fowler, supra note 2, 5. See also Michael Simpson, Robert Buckman, Moira Stewart, Peter Maguire, Mack Lipkin, Dennis Novack, and James Till, ‘Doctor-patient communication: the Toronto consensus statement’, British Medical Journal 303 (1991) 1385.


Fowler, supra note 2, 5-6. See also Olivia Carter-Pokras, Marla J.F. O’Neill, Vasana Cheanvechai, Mikhail Menis, Tao Fan and Angelo Solera, ‘Providing Linguistically Appropriate Services to Persons with Limited English Proficiency: A Needs and Resources Investigation’, The American Journal of Managed Care 10 (Special Issue) (2004) 30.


Priebe et al., supra note 15, 5. Notably, a lack of interpretation might also invoke ethical and legal questions, for instance in relation to informed consent. Carter-Pokras et al., ibid., 31.


Priebe et al., supra note 15, 5; Carter-Pokras et al., supra note 9, 31.


Mary Phelan, ‘Medical Interpreting and the Law in the European Union’, European Journal of Health Law 19 (2012) 336-337.


Phelan, supra note 23 337.


Phelan, supra note 23, 337.


Carter-Pokras et al., supra note 9, 31.


Jelfs and Baeten, supra note 29, 15-16.


Bernier, supra note 38, 7.


Phelan, supra note 23, 353.


Phelan, supra note 23, 353.


Carter-Pokras et al., supra note 9, 35.


Hampers and McNulty, supra note 15. Another us research proved that the length of hospital stays may also be affected by language barriers. It found that ‘the length of a hospital stay for lep patients was significantly longer when professional interpreters were not used at admission or both admission/discharge’. Mary Lindholm, J. Lee Hargraves, Warren J. Ferguson and George Reed, ‘Professional language interpretation and inpatient length of stay and readmission rates’, Journal of General Internal Medicine 27(10) (2012) 1297-1298.


See among others Flores et al., supra note 48, 10; Francesca Gany, Jennifer Leng, Ephraim Shapiro, David Abramson, Ivette Motola, David C. Shield and Jyotsna Changrani, ‘Patient Satisfaction with Different Interpreting Methods: A Randomized Controlled Trial’, Journal of General Internal Medicine 22 (Suppl 2) (2007) 317.


Jelfs and Baeten, supra note 29, 20.


In 2007, about 30 per cent of European citizens were not aware of their cross-border healthcare entitlements, whereas in 2015, 43 per cent could not identify the statement ‘A majority of respondents know that they have the right to be reimbursed for medical treatment in another EU country’ to be true (16 per cent declared it to be false, and 27 per cent could not provide an answer). See supra notes 60 and 62. A German survey found similar trends in 2009: 27 per cent of patients were not aware of their entitlement to have the costs of outpatient treatment in another eu country reimbursed, 47 per cent of patients were not familiar with the European Health Insurance Card and 74 per cent of patients never heard about the Patient Mobility Directive. Techniker Krankenkasse, ‘Europe Survey 2009: German patients en route to Europe’ (2009),, retrieved 18 August 2015. These data might have changed somewhat in the last years, but the level of awareness still calls for action.


Petra Thorn and Sandra Dill, ‘The role of patients’ organizations in cross-border reproductive care’, Fertility and Sterility 94(1) (2010) 24.


  • Solutions for the language gap

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