Reimbursement for medical treatment abroad: the Court of Cassation ‘reinforces’ the right
The case of a child with serious skeletal disorders: the primary and fundamental right to health takes precedence over other interests, even those protected by the Constitution
Key points
The local health authority’s decision to refuse reimbursement of healthcare costs incurred abroad “without taking into account the specific circumstances of the individual clinical case” infringes the fundamental right to health protection. This was ruled by the Court of Cassation (Order No. 20805 of 2026), which ruled on the application of the decree of the Minister of Health of 3 November 1989 (Criteria for the provision of healthcare services indirectly at highly specialised centres abroad).
The background
A child suffering from serious skeletal disorders was granted a five-year authorisation in 2010 for osteopathic and craniosacral treatments at a hospital in New York. In 2015, the Local Health Authority, acting on the advice of the Regional Reference Centre (CRR) for treatment abroad, refused to extend the authorisation. The child’s parents brought legal proceedings against the Local Health Authority, seeking an order requiring it to pay the costs necessary to continue the treatment (€94,965.00). The Court of Rome ordered the Local Health Authority to advance the requested sum due to the lack of assessments regarding the “actual effectiveness of the therapy for the child” and “the outcome of previous treatments administered to the same child”. This decision was upheld by the Rome Court of Appeal on the basis of the opinion expressed by the orthopaedic specialists at the Bambin Gesù Hospital, who had highlighted “the child’s need to continue the ongoing rehabilitation treatment [at] the hospital abroad”.
The order
In its appeal to the Court of Cassation, the Local Health Authority argued that the regional court had ‘unlawfully’ substituted the Regional Reference Centre. This argument fell short of the mark. The Court of Cassation confirmed the established position that:
- the lack of administrative authorisation to provide medical treatment at non-contracted hospitals does not affect the right to reimbursement of expenses incurred, where the trial judge finds that the treatment was provided in an emergency (Court of Cassation, Labour Section, judgment No 9969 of 18 June 2012);
- where a claim by a patient covered by the National Health Service, seeking reimbursement of hospital expenses not authorised in advance, is based on grounds of exceptional gravity and urgency, “the public administration has no discretionary power to grant authorisation”, since ‘the right to health protection, as an inviolable right of the individual, is subject to unconditional protection’ (Civil Court of Cassation, Joint Divisions, judgment No. 117 of 10 March 1999).
