EPHA Policy Seminar: The internal market and healthcare services – a step too far?

1. EPHA Policy Seminar:The internal market and healthcare services – a step too far? 24 June 2005 Flora Giorgio-Gerlach

2. Overview • Health Services: « one size fits all? » • « Recommendations on health services and the internal market » EHPF

3. Health services • Fully private  I.e Alternative medicines • Partially public  I.e Distribution of medicines • Fully public  I.e Hospitals One size fits all?

4. Services Directive How it would affect health services? • Through the establisment measures (Authorisations, screening and notification procedures, Article 15 ) • Through Article 23 which incorporates into EU law recent ECJ judgements on prior authorisation for medical care in another country • Through measures related to quality of services

5. « Recommendations on health services and the internal market » EHPF • History • Participants • Why a EHPF paper • Recommendations • Conclusions

6. History I • EHPF: 46 European associations representing stakeholders active in health sector • Health related NGOs (16 EPHA Members) • Health Professionals/ health providers • Citizens/patients • Industry • Informal Platform for DG SANCO and other DGs to discuss about health policy issues

7. History II • 5 December 2003 EHPF meeting: Adoption of recommendations on health and social policy and request of new working group (EPHA Rapporteur) • Establishment of the EHPF drafting WG on health services and the internal market (Spring 2004) • Several meetings in 2004 and 2005 • Writen consultation until mid April 2005 • Adoption on 3 May 2005

8. Participants • Participants: • AIOP (Associazione Italiana Ospedalità Privata) • CPME (Standing Committee of European Doctors) • EHMA (European Health Management Association) • ENSP (European Network for Smoking Prevention) • EPHA (European Public Health Alliance) • ESIP (European Social Insurance Partners) • EUPHA (European Public Health Association) • Eurocare (European Council for Alcohol Research Rehabilitation and Education) • GIRP (The European Association of Pharmaceutical Wholesalers) • HOPE (Standing Committee of the Hospitals of the European Union) • PCN (The Standing Committee of Nurses of the EU) • RedCross • Coordinators: EPSU - PGEU

9. Why a EHPF Paper • Two important initiatives at EU level for health services: • Commission proposal on services in the internal market (January 2004) • Commission White Paper on SGIs  Future Communication on health and social SGIs (July 2005) • Need to examine the delivery of health services in the context of the internal market and develop recommendations

10. Contents of the Paper • Background • General comments • Specific features of the health sector • Adequate consultation with stakeholders • Proper impact assessment of EU legislation on health • Specific comments • White Paper on Services of General Interest (COM (2004) 374) • Proposal for a Directive on Services in the Internal Market (COM (2004) 2 final) • Conclusions

11. General Recommendations I • Ensuring that the specificity of health services is adequately reflected in any EU initiative • Ensuring that sustainability and long-term objectives of health services are reflected in EU initiatives with an impact on health • Ensuring that adequate consultation takes place in EU initiatives: taking into the representativeness of the respondents, who is consulted and how the comments are taken into account depending on the weight of respondents

12. General Recommendations II • Ensuring that a proper health impact assessment including health system impact assessment is performed prior to any legislative initiative • Coordination between Commission services to ensure consistency of initiatives

13. Recommendations on SGIs • Defining at EU level, health Services of General Interest, taking into account the principles of universality, accessibility, continuity, quality, and affordability • Establishing, at EU level, a general framework for health Services of General Interest which allows Member States to decide on the designation, organisation and financing of SGIs • Examining the legal status of the principle of solidarity and how it is reflected in EU law

14. Recommendations for the Services proposal I • Exclusion of health services from the scope of the proposed Directive in view of examining these services within the framework of separate debate • Clarification of definitions (including “hospital care” and “services”) • Careful examination of the proposed screening mechanism in relation to public health objectives

15. Recommendations on the Services proposal II • Careful examination of the impact of screening mechanism on Member States competencies to organise the delivery of health services at national level • Total derogation from the country of origin principle for health services

16. AER – Assembly of European Regions AESGP – Association of the European Self-Medication Industry AGE – European Older People’s Platform ASPHER – Association of Schools of Public Health in the EU Region BEUC – Bureau Européen des Unions de Consommateurs CHANGE – Coalition of HIV and AIDS Non Governmental Organisations in Europ EAGS – European Alliance of Patients Support Groups for Genetic Services EATG – European Aids Treatment Group EBU – European Blind Union ECH – European Committee for Homeopathy ECL – The Association of European Cancer Leagues EDF – European Disability Forum EFA – European Federation of Allergy and Airways disease Patients EGA – European Generic medicines Association EHMA – European Health Management Association EHN – European Heart Network EHTEL – European Heart Telematics EMA – European Midwives Association ENSP – European Network for Smoking Prevention EPF – European Patient’s Forum EPHA – European Public Health Alliance EPSU – European Federation for Public Service Union ESMHD – European Society for Mental Health and Deafness EUCOMED EUPHA –National Associations of Public Health for the European Public Health Association EUROCARE – Advocacy for the Prevention of Alcohol Related Harm in Europe EuroHealthNet – European Network of Health Promotion Agencies EUROPA DONNA – The European Breast Cancer Coalition EURORDIS – European Organization for Rare Disorders GAMIAN-EUROPE – Global Alliance for Mental Illness Advocacy Networks GIRP – Groupement International de la repartition Pharmaceutique HAI – Health Action International HOPE – Hospitals of EU IAPO – International Alliance of Patients’ Organizations IPPFEN – European Network Parenthood Federation IUHPE – International Union for Health Promotion and Education MHE-SME – Mental Health Europe-Santé Mentale Europe PCN – Standing Committee of Nurses PGEU – Pharmaceutical Group of European Union Red Cross/EU UEHP-CEHP – European Union of Private Hospitals- (approved with specific reservation -see: http://forum.europa.eu.int/Public/irc/sanco/ehf/library) UEMS-EUMS – European Union of Medical Specialists Youth Forum Jeunesse Adopted by:

17. Conclusions Any initiative at EU level should take due account of the specific features of the health services and adequate consultation with stakeholders and a proper impact assessment should be carried out in advance

18. Thank you!