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EPSU Journalists seminar EPSU Journalists seminar 26-27 February 200826-27 February 2008

Proposals for a Health Proposals for a Health Services DirectiveServices Directive??

Towards a better healthcare for Towards a better healthcare for all??all??

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Background & HistoryBackground & History

o Court decisions on patient mobility (e.g. Kohl-Decker, Watts)

o Bolkestein proposals for Services Directive

o Commission Consultation on cross-border health services

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Cross-border healthcare Cross-border healthcare

Includes:o Patient mobilityo Cross-border provision of

serviceso Permanent presence of a

service provider from another Member State

o Mobility of health professionals

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Aim Commission: Aim Commission: Free movement of Free movement of

servicesservicesOverall aim of EU-policy= clear framework for cross-border healthcare in the EU based on principle of free movement of health services

there are two barriers to this freemovement which need to be addressed

specificallyo Uncertainty about the rights of patients

to reimbursement of health care received in other Member States

o Uncertainty about the frameworks for safe and effective healthcare in cross-border situations

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Response CommissionResponse Commission

Directive with three differentelements:o Common principles in all EU

health systemso A specific framework for

cross-border healthcareo European Cooperation on

health services

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Common principles & Common principles & responsibilities Member responsibilities Member

StatesStateso To provide healthcare according to

quality & safety standards of the country in which it is provided and monitor this

o Information about treatment to patientso Possibility to complain and bring a claimo Professional liability insuranceo Right to privacyo Planning and managing healthcare to

ensure universal access to quality care on the basis of equality and solidarity

o Equal treatment between patients from other Member States and nationals of the Member state

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Framework of cross-Framework of cross-border careborder care

o Right for EU-patients to reimbursement of the costs of healthcare provided in another Member State except hospital care

o Hospital care is subject to advance agreement/ prior authorisation (definition hospital care?)

o Level of reimbursement= Level of home country (but not more than actual costs)

o National contact points

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Cooperation between Cooperation between Member StatesMember States

o Duty of Cooperationo Recognition of prescriptions

issued in another Member State

o European reference networkso E-healtho Statistical data collectiono Cooperation on new health

technologies

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Questions to be Questions to be answeredanswered

o How do these proposals relate to the internal market principles in general like the freedom of establishment, and the services directive?

o How can equality and universal service be ensured if level of reimbursement in the EU differs that much?

o What effects will these proposals have in relation to existing/future health care reforms in different EU-member states and neighbourhood countries

o Does this proposal respect the principles of subsidiarity and proportionality ?

o What legal status do general interest principles such as equity, solidarity and accessibility have and how can they be enforced?

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How to respond?How to respond?o Build alliances both at European and at

national levelo Different parties- MEP’s, stakeholders

expressed their concerno Develop a counter strategy in order to

ensure accessible and high-quality services based on the principles of general interest and not on market principles.

o However, we also need to be clear about what we do expect from universal health services in Europe.