Health for everyone

“In some cases the medical treatment of which a patient has a need is more effectively provided in an EU country other than the one in which he/she resides” and so-called “patient mobility” is a right recognized by the European Court of Justice”: that is how the European Commissioner for the health and protection of consumers MARKOS KYPRIANOU explained the public consultation launched by the European Commission in Brussels on 5 September. The aim of the consultation is the creation of a Community framework of reference for the provision of cross-border medical services to European citizens, with a view to guaranteeing patients’ rights and fostering closer cooperation between the health systems of member states. A CLEAR FRAMEWORK. The consultation will be based on a Communication that will be drafted by Commissioner Kyprianou himself, who declares: “The European Court of Justice has ruled that patients have a right to cross-border medical treatment in compliance with EU law, but it is still not entirely clear what, in practice, this may involve”. There is therefore a need for “a clear and concrete framework to enable patients and the institutions that fund, provide and regulate health services to have recourse to cross-border medical treatment and to provide such treatment whenever this solution seems the best”. According to the Commissioner, this “will contribute, at the same time, to releasing a significant potential in terms of European cooperation which will permit improvements in the efficiency of all EU health systems, though in full respect for national prerogatives”. SECURITY, QUALITY AND EFFICIENCY of health services: these are the objectives that need to be pursued. The first stage is a public consultation aimed at sounding out the views of member states, the European Parliament and other interlocutors (patients, healthcare professions, funding agencies) on various aspects of the question. These include the conditions under which cross-border medical treatment should be authorized and reimbursed; the provision of information to patients on the treatment available to them in other member states; the designation of the healthcare authorities responsible for the supervision of the treatment; liability for any damage caused by cross-border medical treatment and related compensation; patients’ rights and the support of health systems through European cooperation. On the basis of the replies to this consultation, the Commission will draw up formal proposals in 2007. AN OPEN DEBATE. The debate on the free circulation of health services, and in particular on “patient mobility”, was opened in 1998, following the rulings of the European Court of Justice on the Kohll and Decker cases, both citizens of Luxembourg resident abroad and beneficiaries of cross-border medical treatment. In its sentences, the Court clarified that the provision of such services is in compliance with the articles of the EU Treaty relating to the free circulation of services. The measures that establish the reimbursement of health costs incurred in another member state and the need for preliminary authorization, however, represent obstacles to this freedom, though these obstacles may be justified by motives of general interest. PUBLIC CONSULTATION. In the 2003 Report of the “high level advisory group” on patient mobility and the development of medical treatment in the European Union, ministers for health and other interlocutors invited the Commission to examine how legal certainty in this area could be reinforced in conformity with the jurisprudence of the European Court. The subsequent draft Directive on services in the internal market, presented by the Commission in early 2004 and also including the aforesaid provisions based on the rulings of the Court, was rejected by the European Parliament and by the Council. This gave rise to the idea of a public consultation, conceived by the Commission as the best way of formulating a specific initiative in the field of health services. The objectives to be pursued include: creation of a European network of centres of reference, cooperation in the evaluation of new technologies in the field, and creation of a platform for the exchange of good practices. A “declaration on common values and principles in EU health services” was adopted on 1st June.