The European Commission finally published the long-awaited draft healthcare directive in July - The Application of Patient Rights in Cross Border Healthcare.

If enacted by member states, this would enshrine formally in their national laws the rights patients have to seek treatment in other countries. They can then get reimbursement from their home country, up to the level it would have cost there. These rights have been recognised many times over by the European Court of Justice.

However, the directive has been watered down. For example, member states are now allowed to require patients to get prior authorisation for foreign hospital care. The Commission recognised that the draft had little chance of success without this concession.

However, the proposal still allows EU citizens the right to seek non-hospital care, such as visits to dentists, opticians and doctors without prior authorisation.

But how soon will the directive be ratified by national governments, and what will be its impact?

Paolo Giordano, Director General of the European Union of Private Hospitals, expects further long delays, as the directive goes through the co-decision process: "First, it has to be passed by the European Parliament and by the European Council of Ministers. If it is passed, then each European country will have to put it into their national law, but this could take another year."

Giordano foresees trouble ahead; Germany and Scandinavia are negative, and the fear in many countries is that the directive would lead to a surge in medical demand, as other Europeans migrate to the countries which offer the best treatments.

He expects "a big fight in Parliament, and in the Council. Germany says it is completely against the directive."

Germany questions whether it doesn't interfere with Article 152 of the Treaty, which gives responsibility for the organisation and delivery of health care to member states.

On balance, Giordano expects a majority to support the directive, but it will be a rough and long ride.