1 EPSU Journalists seminar February 2008 Proposals for a Health Services Directive ? Towards a better healthcare for all??

2 Background & History oCourt decisions on patient mobility (e.g. Kohl-Decker, Watts) oBolkestein proposals for Services Directive oCommission Consultation on cross- border health services

3 Cross-border healthcare Includes: oPatient mobility oCross-border provision of services oPermanent presence of a service provider from another Member State oMobility of health professionals

4 Aim Commission: Free movement of services Overall 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 free movement which need to be addressed specifically oUncertainty about the rights of patients to reimbursement of health care received in other Member States oUncertainty about the frameworks for safe and effective healthcare in cross-border situations

5 Response Commission Directive with three different elements: oCommon principles in all EU health systems oA specific framework for cross- border healthcare oEuropean Cooperation on health services

6 Common principles & responsibilities Member States oTo provide healthcare according to quality & safety standards of the country in which it is provided and monitor this oInformation about treatment to patients oPossibility to complain and bring a claim oProfessional liability insurance oRight to privacy oPlanning and managing healthcare to ensure universal access to quality care on the basis of equality and solidarity oEqual treatment between patients from other Member States and nationals of the Member state

7 Framework of cross-border care oRight for EU-patients to reimbursement of the costs of healthcare provided in another Member State except hospital care oHospital care is subject to advance agreement/ prior authorisation (definition hospital care?) oLevel of reimbursement= Level of home country (but not more than actual costs) oNational contact points

8 Cooperation between Member States oDuty of Cooperation oRecognition of prescriptions issued in another Member State oEuropean reference networks oE-health oStatistical data collection oCooperation on new health technologies

9 Questions to be answered oHow do these proposals relate to the internal market principles in general like the freedom of establishment, and the services directive? oHow can equality and universal service be ensured if level of reimbursement in the EU differs that much? oWhat effects will these proposals have in relation to existing/future health care reforms in different EU-member states and neighbourhood countries oDoes this proposal respect the principles of subsidiarity and proportionality ? oWhat legal status do general interest principles such as equity, solidarity and accessibility have and how can they be enforced?

10 How to respond? oBuild alliances both at European and at national level oDifferent parties- MEP’s, stakeholders expressed their concern oDevelop a counter strategy in order to ensure accessible and high-quality services based on the principles of general interest and not on market principles. oHowever, we also need to be clear about what we do expect from universal health services in Europe.