5 Patient mobility and healthcare development
in the European Union
| (25573)
8682/04
COM(04) 301
| Commission Communication: Follow-up to the high-level reflection process on patient mobility and healthcare developments in the European Union
|
| Legal base | — |
| Document originated | 20 April 2004
|
| Deposited in Parliament | 27 April 2004
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| Department | Health |
| Basis of consideration | EM of 11 May 2004
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| Previous Committee Report | None
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| To be discussed in Council | 1 and 2 June 2004
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| Committee's assessment | Politically important
|
| Committee's decision | Not cleared; further information requested
|
Background
5.1 Article 152(1) of the EC Treaty says that a high level of
human health protection must be ensured in the definition and
implementation of all Community policies and activities. Community
action, which is to complement Member States' policies, is to
be directed to improving public health, preventing illness and
reducing risks to human health.
5.2 Article 152(2) says that the Community is to
encourage and support cooperation between Member States in matters
of public health. Member States are to coordinate their public
health policies and programmes. The Commission is given discretion
to take any useful initiative to promote such coordination.
5.3 Nationals of a Member State may seek non-hospital
treatment in any other Member State provided they are entitled
to it in their home country. They do not have to obtain prior
authorisation and they can seek reimbursement of the cost from
their home country. Moreover, if nationals obtain prior authorisation
from their home country, they can seek hospital treatment in any
other Member State; again, there is provision for the reimbursement
of costs. And nationals staying temporarily in another Member
State — say, for study or travel — can receive healthcare
without prior authorisation and on the same terms as people insured
in that country.
5.4 In the light of the conclusions of the Health
Council in June 2002, a High Level Group on Patient Mobility and
Health Care was set up. The Group included health ministers from
across the EU and representatives of the European Parliament,
patients, providers of healthcare and health insurers. The Group
issued a report in December 2003. It made 19 recommendations,
most of them addressed to the Commission.
The document
5.5 The Communication contains the Commission's response
to the High Level Group's recommendations and has four main sections:
- European cooperation to enable
better use of resources;
- information requirements of patients, professionals
and policy-makers;
- the European contribution to health objectives;
and
- responding to enlargement through investment
in health and health infrastructure.
A list of the recommendations and the Commission's
response to each of them is attached to the Communication.
EUROPEAN COOPERATION TO MAKE BETTER USE OF RESOURCES
5.6 The Commission says that there are many examples
of existing cooperation which is to the benefit of patients, providers
and the use of healthcare resources. It cites the referral of
patients from one Member State to another in border regions or
where there is insufficient healthcare capacity in one area and
a surplus elsewhere. But these are mainly local initiatives and
there has not been a pooling of experience. The High Level Group
recommended an evaluation of cross-border projects and the development
of networks to share best practice. The Commission will arrange
such a study and will also take forward the Group's ideas about
the possibility of drawing up a framework that Member States could
use when purchasing healthcare services from each other.
5.7 The Commission says that the mobility of patients
can be not only in their interests but also enable better use
of resources. It says that obtaining these benefits will be helped
by the new Community legislation to simplify the rules on the
coordination of social security systems and on the introduction
of a European health insurance card. The Communication also calls
on Member States to review and, if appropriate, clarify their
systems of entitlement to benefits for medical treatment in another
State.
5.8 The Commission stresses the importance of mobility
among healthcare professionals. The current draft Directive on
the mutual recognition of professional qualifications is intended,
among things, to facilitate such mobility.
5.9 There is already a shortage of health professionals
which, for demographic reasons, is likely to get worse. The Commission
calls on Member States to provide better statistical information
on the mobility of these professionals. It also floats the idea
of a concerted European strategy for the recruitment, training
and conditions of service of healthcare staff.
5.10 The Commission notes that "European centres
of reference" could provide healthcare to patients who have
rare diseases or conditions calling for a concentration of expertise
or special facilities. The Commission will take action on the
High Level Group's recommendation about the mapping of centres
of reference and may make proposals for cooperation between Member
States in the light of the results of the analysis.
5.11 New drugs, techniques and equipment need evaluation
in the interest of patients and taxpayers. The High Level Group
invited the Commission to consider how a network for the assessment
of health technology could be organised and funded. The Commission
says that it plans to establish a coordinating mechanism to link
the organisations and agencies already concerned with such evaluations
and to pool the results.
INFORMATION REQUIREMENTS
5.12 The High Level Group invited the Commission
to develop a framework for health information at the EU level,
taking account of the information needs of policy-makers, patients
and healthcare professionals. The Communication refers to work
already in progress to identify needs and establish databases
and says that this work will provide a solid basis for developing
a coherent European information strategy.
5.13 The Commission plans studies of the motivation
for and scope of cross-border care. It also refers to work on
and proposals for the use of information technology to provide
patients and professionals with information.
EUROPEAN CONTRIBUTION TO HEALTH OBJECTIVES
5.14 The Commission says that it will build on work
already in progress on extended impact assessments to ensure that
the effect of its future proposals for healthcare are fully evaluated.
5.15 The High Level Group invited the Commission
to consider the development of a permanent mechanism at EU level
to support European cooperation on matters concerned with healthcare.
In response, the Commission says that it has decided to use its
powers under Article 152 of the EC treaty to establish a "High
Level Group on Health Services and Medical Care". The Group
will not only promote cooperation between Member States but also
take forward work on such matters as sharing spare capacity, centres
of reference and the assessment of new technologies. The members
of the Group will be senior representatives of the Member States
and of the Commission.
5.16 The Commission comments:
"Health services and medical care are primarily
the responsibility of the Member States and should remain so.
However, it is clear from the conclusions of the reflection process
that there is great potential for cooperation at European level
to help patients to have high-quality healthcare and to help health
systems to improve their effectiveness and efficiency. Respecting
national responsibility for health systems does not mean doing
nothing at European level. Rather, this Committee [the proposed
new High level Group] can ensure that there are structures in
place to facilitate cooperation where useful and ensure that where
Europe does have an impact on health [and] health systems, it
does so in a positive way and that those responsible for achieving
health objectives can shape those developments".[9]
RESPONDING TO ENLARGEMENT THROUGH INVESTMENT IN HEALTH
AND HEALTH INFRASTRUCTURE
5.17 The Commission notes that life expectancy and
spending on healthcare in the new Member States is significantly
lower than in the rest of the Community. In response to the High
Level Group's concerns about this, the Commission says that financial
support for investment in healthcare will be available from the
Community's cohesion funds; it is for the regions and Member States
to identify projects which deserve priority.
The Government's view
5.18 The Minister of State for Health at the Department
of Health (Mr John Hutton) tells us that most of the action proposed
by the Commission is for information sharing or the use of existing
mechanisms. The Government is considering how the proposed new
High Level Group on Health Services and Medical Care might best
relate to the other strands of Community activity affecting healthcare.
Conclusion
5.19 We recognise the potential benefits of the
work the Commission proposes, such as the exchange of experience,
cooperation in the evaluation of new drugs and techniques and
helping patients, professionals and policy-makers to obtain access
to necessary information. We note, however, that the Communication
does not provide any estimate of the cost of the proposed activities;
nor does it explain their relative priority. We also note that
the Government is reflecting on the role of the new High Level
Group.
5.20 We should be grateful for the Minister's
comments on the points we have noted and to be told the outcome
of the discussion of the Communication at the Health Council in
June. We shall keep the document under scrutiny pending his reply.
9 Page 16 of the Communication. Back
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