Integrating Health across Policies Health and the Single European Market Coheur Alain : Association Internationale de la Mutualité

FREE MOVEMENT OF PATIENTS - Dynamics and evolution of the European context - Dynamics of the Euregios - Cross border experiments - Divergences, convergences and perspectives GASTEIN : 27 septembre 2001

Dynamics of the European context Bilateral agreements - Regulations 1408/71 - Treaties : Rome - Maastricht - Amsterdam - Charters : Social Charter - of fundamental right - Recommendations - Communications - Councils : Luxembourg - Lisbon - Nice - Judgments

European dynamics 1868 Year Arrest Kohl Decker ……... Nederlands - Belgium France - Belgium Germany - Belgium Care providers Treaty of Maastricht First bilateral conventions Communications from the Commission Treaty of Amsterdam Charter of fundamental rights art. 34 et 35 Charter of fundamental rights art. 34 et 35 Treaty of Rome art 42 Reg. 1408/71 Recommendat° Conv. goals social protect° European social Charter art. 11

The dynamic of the Euregios % of the Community’s territory % fo the population Interreg I => II - III support for the development and complementary in CB method of partnership and bottom up approach grassroots visibility for the citizens budget are not allocated to the individual member state but by border Each Euregio has a great deal of leeway as regards applying the guidelines Euregio Meuse Rhin => eight priorities “improving cooperation and cross-boder accessibility in health care

Contractual practices Number of journeys between Maastricht (Transfusion Centre) and Hermalle hospital May JuneJulyAug.Sept.Oct.Nov.Dec.Jan. Feb.Mar Total number of journeys: 46 Number of blood bags delivered to Hermalle hospital. May JuneJulyAug.Sept.Oct.Nov.Dec.Jan. Feb.Mar Total number of blood bags delivered: 130 ¤ Cross-border experiments

 Cross-border experiments Full mobility CAREFrench patients Belgian patients receiving care in Belgium receiving care in France OUTPATIENT CARE173 patients / 273 examinations Scanner = 28% Other medical imag. = 14% Neurology = 18% Nuclear medicine = 12% ONE DAY CLINIC12 patients / 59 fixed cost Intravenous perfusion = 24 Chemotherapy = 29 Surgery = 5 Scanner = 1 INPATIENT CARE8 patients18 patients Functional rehabilitation = 13 Haemodialysis = 2 Other = 3 TOTAL193 patients18 patients

¤ Cross-border experiments Full mobility - on the scope of the mobility - on the main reason for recourse to cross-border care - on geographical accessibility - on the consumer profile - on the type of medical specialities

¤ Cross-border experiments Types of medical specialities Belgium Germany Total 1Ophthalmology (17%) 2Gynaecology (12%) 3Orthopaedics (11%) 4Internal medicine (10%) 5Dermatology (9%) 6Scan (8%) Etc.

 Divergences historical and legal development of European social models the organisation and financing of social security and health insurance the role played by the publics authorities, the social partners ans private organisations in the decision- making process and the implementation of health systems  a restrictive policy on access to cross-border  a liberal policy on access the room of maneouvre within the Euregios is very small  the room of maneouvre within the Euregios is very small

Convergences Convergences the consequences of the Legal rulings by the European Communities the development on a national level the uniqueness of the Eurogios the growing diversity in cross-border circulation the proximity of the care

êa relaxation in the cross-border care arrangements, with accessibility for all insured persons, and with the greatest common denominator as regards what is laid down in the arrangements ( for two or three countries, depending on the Euregio involved) for social security coverage in respect of health care; êthe emergence of a cross-border traffic for local care supplementing, where necessary, what can be provided to insured persons in their own country; êan extension to patients and insured persons from other Euregios, in the context of bilateral and multilateral (experimental) arrangements, cross-border care which at the outset will be available only to the residents of one Euregio and mainly for high-technology care.  Perspectives

The Euregio projects should receive greater support from the European authorities. A complete listing of all cross-border initiatives should be prepared, a survey of Euregio infrastructure should be carried out, and a profile of the populations involved should be drawn up. This information would make it possible to draw up a specific action programme for the development of cross-border activities in the field of health. The effect of this proposal could be to remove the obstacles to the reform of Regulation 1408/71 by offering new prospects in the field of health.The Euregio projects should receive greater support from the European authorities. A complete listing of all cross-border initiatives should be prepared, a survey of Euregio infrastructure should be carried out, and a profile of the populations involved should be drawn up. This information would make it possible to draw up a specific action programme for the development of cross-border activities in the field of health. The effect of this proposal could be to remove the obstacles to the reform of Regulation 1408/71 by offering new prospects in the field of health.  CONCLUSIONS