The Directive 24/11 has a positive plant, and it can become a tool not only to heal traveling, but to claim that in every place of care, in every state, region or local health services, there is the possibility to have equal rights to access to health care, information on the free choice, innovation, quality and safety of care, to the complaint.

For this reason, patients’ associations have clearly shown that the innovative potential expressed by the Directive is strong and thus they are committed to work for its implementation.
The opportunity to access quality information, the guarantee of safety in healthcare, the right to compensation and alternative forms for dispute resolution are just some of the aspects that will bring about major breakthroughs in many countries by strengthening the rights not only for those who travel for health reasons, but also for people who live in any Member state and use its healthcare system.
In view of this potential, However, the associations of ACN partners express some concerns, that on 23 October we wanted to spread directly to the DG SANCO, in a meeting which was attended by a delegation of partners of ACN. After that, the main negative aspects:

• the transposition process has been slow and almost "in the dark";
• the involvement of citizens' organizations is yet to be considered a priority and a way of ordinary governance of the National Public Health system;
• information to the public in general and to patients in particular on their rights under the Directive is currently lacking, as well as communication strategies which should inform the population as effectively as possible.
• Member States seem much more concerned with technical and legal issues related to the adaptation and revision of the national legislation than with the management of the short term practical implications of these provisions. This is demonstrated by the following arguments:

• the knowledge that in several countries, e.g. Estonia, Latvia and Austria (where the transposition law changes as many as 18 Federal Acts), the transposition of the Directive requires a substantial adaptation of the existing legislation;
•  albeit partial, the involvement of patients' associations and the protection of their rights has been recorded only in the transposition phase of the Directive, against a total lack of consulting the associations by the National Contact Points, although expressly provided for by the Directive.

This being the case, the associations foresee that only a small percentage of patients will request treatment abroad.

In addition to these general concerns there are more detailed ones, specifically related to both the transposition of the Directive and its practical impact.

Concerns regarding the transposition of the Directive:

• The Directive leaves Member States too much discretion: in fact there are too many cases where it is stated that "the State should/could "rather than" the State must ". This can give rise to a liberal interpretation of the Directive from Country to Country.
• In some cases, the law does not mention aspects of national implementation which are an important part of the Directive, such as those regarding information.

Concerns regarding practical implications:

• the cuts to public health and the current lack of investment funds are likely to prevent the principles of the Directive being implemented and respected.
• the provisions of the Directive may be hindered by a cultural approach since health workers should be the first to be more open and available to patients from other countries.
• language is the main obstacle in reading/understanding medical prescriptions since the Directive does not indicate that Member States adopt specific rules about it.
• associations believe that patient self-guidance in the choice is a possible critical issue.
• they disapprove of the fact that each patient should anticipate the cost of treatment abroad and then ask for reimbursement.
• countries which are economically disadvantaged or live on tourism (particularly attractive for older people who may decide to spend their retirement in a country other than their own) fear the depletion of the health service for nationals, too much debt or longer waiting lists.

Finally, the changes introduced by the implementation of the Directive also affect patients' organizations, since in some cases the main concern is not the fact of being involved in the implementation in itself but it is the lack of internal resources that specialize in theme and in a position to offer citizens of all the relevant information they may need.

Mariano Votta, Director Active Citizenship Network