Cross-border healthcare demands EU response 

The main issues raised at the round table were:

• movement of patients and healthcare professionals in the EU-25;
• health inequalities and differences in income levels;
• particular concerns of border regions;
• 'public health' versus a general health provision in the EU Treaty;
• establishment of a 'permanent mechanism' to support EU-wide co-operation on healthcare;
• funding of healthcare projects under the EU's structural and cohesion funds;
• a new directive on services in the internal market which incorporates recent Court rulings;
• whether the EU should have more competence in the area of health.

The speaker for the  European Public Health Alliance complained that the high-level reflection process was a "political opportunity missed" to re-define (and increase) the EU's competence in the field of health. The speaker also noted that representatives of the 'European citizen' were missing from the discussions.

Government officials from the UK and the Ne therlands were in favour of the establishment of a 'permanent mechanism' to support EU-wide co-operation on health care and to monitor the impact of the EU on health systems, bringing forward proposals when necessary. The healthcare sector is responsible for up to ten per cent of the GDP, depending on the Member State. Health should be viewed as an investment in society and the economy and should move higher up on the political agenda. Health ministers should have the final say when dealing with the free movement of patients.

Speakers from the  Commission's DG Health and Consumer Protection emphasised the fact that there are no EU Treaty provisions on 'health'. Provisions on 'public health' were introduced by the Maastricht Treaty in 1992, but no clear definition of the term was provided. Generally speaking, the EU is entitled to take action in a range of areas other than those directly affecting health systems, which remains an area of Member State competence. Some rules in other policy areas, notably in environment, the internal market or the co-ordination of social security systems, have also had some impact on health and health systems. Recent Court rulings on patient mobility, however, directly affect the health systems of Member States.

The high-level reflection group provided a good opportunity to discuss possible ways for action and now it remains to be seen whether the political will exists at European level to take the necessary steps. The Commission is due to release its own proposals based on the high-level group's recommendations "in the coming weeks".

The speaker representing  DG Internal Market of the Commission highlighted the health provisions of the Commission's proposal for a directive on services in the internal market. This draft proposal discusses the relationship between authorisations for treatment abroad as it relates to the principle of freedom of movement for services. The speaker explained that the new proposal incorporates recent rulings of the Court and does not go beyond them.

The speaker representing the  Hungarian government said that the reflection process had provided a good opportunity for the new Member States to find out more about cross-border arrangements for healthcare. One worry for Hungary is the increased mobility of healthcare professionals due to higher income levels in the EU-15. Hungary welcomes EU funding for healthcare projects under the Structural Funds for 2004-2006.

A representative of the  state of North Rhine-Westphalia pointed out that border crossing healthcare in her region is a part of everyday life. Her view was that more transparency and co-operation on healthcare matters would be necessary to enhance the EU integration process. She also recommended the establishment of a forum for regular health dialogue to bring together the EU institutions and the major stakeholders.

A speaker for the  Standing Committee of European Nurses commented on the mobility of healthcare professionals, notably nurses. The representative said that the mobility of healthcare professionals is not so much a European as a global issue. He spoke out in favour of agreeing long-term strategies for increasing the size of the domestic health workforce, the development of best practice guidlines on international recruitment and the establishment of a formal consultation structure to guarantee professional development in the EU.