The differences between the different European health care systems justify the mobilisation of stakeholders at EU level for obvious political and moral reasons, writes Arnaud Senn for the Robert Schuman Foundation.
In the 1970s, the EU “transcribed” the free movement of persons rule into healthcare systems by creating the European medical form “E111”, which was replaced by the European Health Insurance Card in June 2004, recalls the author. The legitimacy of the European Community’s involvement in health services was later established in the Treaties and Constitution project, which marked another decisive step on the path towards a European health policy.
However, these legal clauses had a limited impact on the life of the insured, as they were still basically dependent on their home states in terms of medical care abroad, says the author. The situation has much evolved with following successive rulings of the European Court of Justice, such as the ‘Kholl and Decker’ case, he notes.
The latter case stated that if the insured person receives medical treatment abroad, the home state tariffs apply if they are higher than the one applicable in the providing state. The ‘Doc Morris’ case made the sale of drugs on the internet possible without medical prescription.
The author also addresses the issue of member state cooperation in the health sector. He outlines the role of the European Regional Development Fund (ERDF), which enables the cooperation of health actors ‘on the ground’. A number of regional cooperation projects made the identification of difficulties affecting patient mobility possible and led to pragmatic solutions – such as the agreement concluded between Belgium, the Netherlands and Germany that facilitates the administrative management of patients.
On 26 September 2006, the Commission launched a public consultation on Community action on health services in order to draw up specific proposals in 2007. The author outlines a number of requirements that should be brought into balance in the future proposal:
- Patient mobility and financial issues: The financial impact at local level, in particular in cross-border regions, can be significant if such specific situations are neglected.
- Freedom of actors and judicial security: The lack of a clear judicial framework hinders European cooperation.
- European dynamism and the subsidiarity principle: It is essential that member states remain liable for the effective functioning of their national health care systems.
As Europeans and national actors will be increasingly involved in some kind of cooperation, as well as regarding the need for judicial security for patients, the status quo seems difficult to maintain in the health sector, concludes the author. The EU can therefore play a “federative” role in cooperation with member states to the benefit of all citizens, he adds.