A long-awaited proposal to codify the circumstances under which EU patients can legitimately be covered for treatment received in other member states could be either redrafted, withdrawn or downgraded, EURACTIV has learnt.
After repeated delays, the proposal for a framework directive for cross-border healthcare in the EU was shelved on 19 December 2007 due to internal disagreement within the Commission and heavy criticism from some MEPs.
Several Commissioners’ cabinets have reservations about the proposal, including that of Margot Wallström, vice-president of the Commission in charge of relations with the European Parliament and the Council. Wallström had, according to her spokesman, felt that the Commission proposal did not have enough support from the two other institutions to be finally adopted.
Wallström believes that “more thought and reflexion need to be put into the proposal, in particular the reimbursement system, and its consequences,” explained spokesman Joseph Hennon, adding that the Commission has been asked to redraft the proposal.
A representative of a medical stakeholders’ organisation agreed with Wallström, arguing that “the impact assessment done on the proposal in autumn 2007 was not really one as the impacts cannot be predicted. In addition, we need to be aware that the proposal, as it currently stands, would increase inequality between rich and poor as not everybody could afford to pay for care in advance and wait to be reimbursed.”
“This is also an issue between the rich and poor EU member states,” added the representative. Health care costs vary widely across the EU, so it would be easier for rich countries to reimburse cheaper care abroad than for poor countries to reimburse their nationals seeking expensive care in wealthier countries.
One of the reasons put forward for holding up the proposal concerns fears that it could be considered as ‘the second Bolkestein Directive’. This could come at a politically sensitive time for the EU in the run-up to the ratification of the Lisbon Treaty and thus jeopardise – yet again – the EU’s institutional reform.
“This is why Commission President Barroso also wants to delay the proposal,” said another source, adding that publishing an “interpretative communication” on the issue now would help postpone the legislative proposal until the next Commission.
One diplomatic source acknowledged that the proposal is a “politically difficult issue” and that there is “something similar” in it to the Bolkestein directive, which caused street demonstrations in 2005. “Some are, however, only using the proposal as a political pawn and exaggerate the threats. The directive is not about liberalising health services, but codifying the circumstances under which people can legitimately be covered by their national health systems for treatment received abroad,” argued the diplomat.
He also said that the Commission should have been more transparent over the proposal from the beginning, publishing it much earlier in order to launch discussions.
Most member states seem to support the idea of a framework directive, but have insisted on attaching heavy conditions to it. Sweden is one of the countries backing the Commission proposal and the opposite stance adopted by its own Commissioner Wallström has drawn criticism in the country.
The Commission may eventually consider taking the most difficult issues, such as the reimbursement systems, out of the draft and presenting them in the form of a Communication instead. However, this is something that would “completely empty the framework directive of its substance,” the source said.
According to a Commission spokeswoman, the proposal is still scheduled for publication at the “beginning of 2008”.