EU to study impact of cross-border health care

“The core challenge in cross-broder access to health care is to ensure that political goals combine both the objectives of health-care systems and those of the internal market,” the Commission has stated.

The Centre for Health & Ethics in Society (CHES) and the London Royal College of Physicians organised, on 6 December 2006, a health stakeholder round table discussion on the consultation regarding EU action on health services.

“There are big, inexplicable, variations in health-care outcomes between the EU member states and our technology know-how is not used as efficiently as it should,” said Nick Fahy, deputy head of the Commission’s health strategy unit. “This means, politically, that member states have a huge potential to learn from each other to improve efficiency and equity of health care. The political vision just needs to be clear so that we get the technicalities right,” he added. 

He also thinks that the past European Court of Justice rulings have left ‘too much uncertainty’ on the field and, therefore, the Commission now needs to study the impact of cross-border care to national systems, bring legal certainty to the field, evaluate EU action in support to member states and consider the type of instruments to be used for this purpose (regulation, soft legislation or communication).

“We need to balance social and market objectives – those of health-care systems and those of internal market. Political objectives need to combine both and that is the core challenge of what we need to do,” added Fahy.

"According to the Treaty, health is a member states' competence and we need to respect that. We should not touch the issue unless we have extremely good grounds for doing so," said the health attaché of the Finnish Permanent representation. "However, we need something to protect health systems against the Court's case-law. I'd prefer a narrow scope for action - something that can actually be dealt with and on which the EU can really bring some clarification and/or value added. I'm worried that if we go quickly to regulation, we might be entering a chain of regulations. Therefore directive would be better."

The health attaché of the German Permanent representation presented the Germany's initial response to the consultation saying that "the 2007 Communication should clearly separate four things: the case of long-term residents, the status of which need to be reformed; the case of real cross-border movers seeking health care, on which we need legislation and some kind of co-operation mechanism between the member states, such as bilateral treaties; the mobility of health professionals, on which clarification is needed, and; legal certainty of the systems themselves, some steering instruments to guarantee the sustainability of the systems.

"We have to find a solid ground for legislative acts - otherwise we are in trouble," said Rotislava Dimitrova, a policy adviser at the European Parliament.

Tamsin Rose, representing the Swedish national health institue highlighted the importance of continuity of care (ensuring quality) in case of the use of cross-border health services. She also said that those paying themselves (private care seekers) and those sent by/reimbursed by their national governments, who are the ones "causing panic to national health care systems" need to be separated. In the end, the "elephant in the kitchen" question, according to her, is to know whether private seekers of health care should be reimbursed as well.

The Commission adopted, in September 2006, a Communication for consultation regarding the establishment of an EU framework on healthcare services to ensure cross-border access to safe, high-quality and efficient care. The focus is to provide legal certainty for cross-border patients and help co-operation between member states' health services.

Public consultation on the Commission Communication is currently under way.

  • Public consultation on the Commission Communication is open until 31 January 2007. 
  • The Commission will, later in 2007, come up with concrete proposals for Community action on the issue. 

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