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EPHA Policy Seminar:The internal market and healthcare services – a

step too far?

24 June 2005

Flora Giorgio-Gerlach

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Overview

Health Services: « one size Health Services: « one size fits all? » fits all? »

« Recommendations on « Recommendations on health services and the health services and the internal market » EHPFinternal market » EHPF

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Health services

• Fully private Fully private I.e Alternative medicines I.e Alternative medicines

• Partially public Partially public I.e Distribution of medicines I.e Distribution of medicines

• Fully public Fully public I.e Hospitals I.e Hospitals

One size fits all?

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Services Directive

How it would affect health services?How it would affect health services?

Through the establisment measures Through the establisment measures (Authorisations, screening and notification (Authorisations, screening and notification procedures, Article 15 ) procedures, Article 15 )

Through Article 23 which incorporates into EU Through Article 23 which incorporates into EU law recent ECJ judgements on prior law recent ECJ judgements on prior authorisation for medical care in another countryauthorisation for medical care in another country

Through measures related to quality of services Through measures related to quality of services

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« Recommendations on health services and the internal market » EHPF

HistoryHistory ParticipantsParticipants Why a EHPF paperWhy a EHPF paper RecommendationsRecommendations ConclusionsConclusions

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History I

EHPF: 46 European associations EHPF: 46 European associations representing stakeholders active in health representing stakeholders active in health sector sector Health related NGOs (16 EPHA Members)Health related NGOs (16 EPHA Members) Health Professionals/ health providers Health Professionals/ health providers Citizens/patients Citizens/patients Industry Industry

Informal Platform for DG SANCO and other Informal Platform for DG SANCO and other DGs to discuss about health policy issuesDGs to discuss about health policy issues

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History II

5 December 2003 EHPF meeting: Adoption of 5 December 2003 EHPF meeting: Adoption of recommendations on health and social policy recommendations on health and social policy and request of new working groupand request of new working group (EPHA (EPHA Rapporteur)Rapporteur)

Establishment of the Establishment of the EHPF EHPF drafting WG on drafting WG on health services and the internal market health services and the internal market (Spring 2004)(Spring 2004)

Several meetings in 2004 and 2005Several meetings in 2004 and 2005 Writen consultation until mid April 2005Writen consultation until mid April 2005 Adoption on 3 May 2005Adoption on 3 May 2005

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Participants

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

Coordinators: EPSU - PGEUCoordinators: EPSU - PGEU

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Why a EHPF Paper

Two important initiatives at EU level for health Two important initiatives at EU level for health services:services: Commission proposal on services in the internal Commission proposal on services in the internal

market (January 2004)market (January 2004) Commission White Paper on SGIs Commission White Paper on SGIs Future Future

Communication on health and social SGIs (July 2005) Communication on health and social SGIs (July 2005)

Need to examine the delivery of health Need to examine the delivery of health services in the context of the internal market services in the context of the internal market and develop recommendationsand develop recommendations

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Contents of the Paper

BackgroundBackground General commentsGeneral comments

Specific features of the health sectorSpecific features of the health sector Adequate consultation with stakeholdersAdequate consultation with stakeholders Proper impact assessment of EU legislation on healthProper impact assessment of EU legislation on health

Specific commentsSpecific comments White Paper on Services of General Interest (COM (2004) White Paper on Services of General Interest (COM (2004)

374)374) Proposal for a Directive on Services in the Internal Market Proposal for a Directive on Services in the Internal Market

(COM (2004) 2 final)(COM (2004) 2 final) ConclusionsConclusions

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General Recommendations I

Ensuring that the specificity of health services is Ensuring that the specificity of health services is adequately reflected in any EU initiativeadequately reflected in any EU initiative

Ensuring that sustainability and long-term Ensuring that sustainability and long-term objectives of health services are reflected in EU objectives of health services are reflected in EU initiatives with an impact on healthinitiatives with an impact on health

Ensuring that adequate consultation takes place Ensuring that adequate consultation takes place in EU initiatives: taking into the in EU initiatives: taking into the representativeness of the respondents, who is representativeness of the respondents, who is consulted and how the comments are taken into consulted and how the comments are taken into account depending on the weight of respondentsaccount depending on the weight of respondents

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General Recommendations II

Ensuring that a proper health impact Ensuring that a proper health impact assessment including health system assessment including health system impact assessment is performed prior to impact assessment is performed prior to any legislative initiativeany legislative initiative

Coordination between Commission Coordination between Commission services to ensure consistency of services to ensure consistency of initiatives initiatives

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Recommendations on SGIs

Defining at EU level, health Services of General Defining at EU level, health Services of General Interest, taking into account the principles of Interest, taking into account the principles of universality, accessibility, continuity, quality, and universality, accessibility, continuity, quality, and affordabilityaffordability

Establishing, at EU level, a general framework for Establishing, at EU level, a general framework for health Services of General Interest which allows health Services of General Interest which allows Member States to decide on the designation, Member States to decide on the designation, organisation and financing of SGIsorganisation and financing of SGIs

Examining the legal status of the principle of solidarity Examining the legal status of the principle of solidarity and how it is reflected in EU lawand how it is reflected in EU law

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Recommendations for the Services proposal I Exclusion of health services from the scope of Exclusion of health services from the scope of

the proposed Directive in view of examining the proposed Directive in view of examining these services within the framework of these services within the framework of separate separate debate debate

Clarification of definitions (including “hospital Clarification of definitions (including “hospital care” and “services”) care” and “services”)

Careful examination of the proposed screening Careful examination of the proposed screening mechanism in relation to public health objectivesmechanism in relation to public health objectives

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Recommendations on the Services proposal II Careful examination of the impact of Careful examination of the impact of

screening mechanism on Member screening mechanism on Member States competencies to organise the States competencies to organise the delivery of health services at national delivery of health services at national levellevel

Total derogation from the country of Total derogation from the country of origin principle for health servicesorigin principle for health services

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Adopted by:AER – Assembly of European RegionsAER – Assembly of European RegionsAESGP – Association of the European Self-Medication IndustryAESGP – Association of the European Self-Medication IndustryAGE – European Older People’s PlatformAGE – European Older People’s PlatformASPHER – Association of Schools of Public Health in the EU RegionASPHER – Association of Schools of Public Health in the EU RegionBEUC – Bureau Européen des Unions de ConsommateursBEUC – Bureau Européen des Unions de ConsommateursCHANGE – Coalition of HIV and AIDS Non Governmental Organisations in CHANGE – Coalition of HIV and AIDS Non Governmental Organisations in

EuropEuropEAGS – European Alliance of Patients Support Groups for Genetic ServicesEAGS – European Alliance of Patients Support Groups for Genetic ServicesEATG – European Aids Treatment GroupEATG – European Aids Treatment GroupEBU – European Blind UnionEBU – European Blind UnionECH – European Committee for HomeopathyECH – European Committee for HomeopathyECL – The Association of European Cancer LeaguesECL – The Association of European Cancer LeaguesEDF – European Disability ForumEDF – European Disability ForumEFA – European Federation of Allergy and Airways disease PatientsEFA – European Federation of Allergy and Airways disease PatientsEGA – European Generic medicines AssociationEGA – European Generic medicines AssociationEHMA – European Health Management AssociationEHMA – European Health Management AssociationEHN – European Heart NetworkEHN – European Heart NetworkEHTEL – European Heart TelematicsEHTEL – European Heart TelematicsEMA – European Midwives AssociationEMA – European Midwives AssociationENSP – European Network for Smoking PreventionENSP – European Network for Smoking PreventionEPF – European Patient’s ForumEPF – European Patient’s ForumEPHA – European Public Health AllianceEPHA – European Public Health AllianceEPSU – European Federation for Public Service UnionEPSU – European Federation for Public Service UnionESMHD – European Society for Mental Health and DeafnessESMHD – European Society for Mental Health and DeafnessEUCOMEDEUCOMEDEUPHA –National Associations of Public Health for the European Public EUPHA –National Associations of Public Health for the European Public

Health Health Association AssociationEUROCARE – Advocacy for the Prevention of Alcohol Related Harm in EUROCARE – Advocacy for the Prevention of Alcohol Related Harm in

EuropeEurope

EuroHealthNet – European Network of Health Promotion EuroHealthNet – European Network of Health Promotion AgenciesAgencies

EUROPA DONNA – The European Breast Cancer CoalitionEUROPA DONNA – The European Breast Cancer Coalition

EURORDIS – European Organization for Rare Disorders EURORDIS – European Organization for Rare Disorders GAMIAN-EUROPE – Global Alliance for Mental Illness GAMIAN-EUROPE – Global Alliance for Mental Illness Advocacy NetworksAdvocacy Networks

GIRP – Groupement International de la repartition GIRP – Groupement International de la repartition PharmaceutiquePharmaceutique

HAI – Health Action InternationalHAI – Health Action International

HOPE – Hospitals of EUHOPE – Hospitals of EU

IAPO – International Alliance of Patients’ OrganizationsIAPO – International Alliance of Patients’ Organizations

IPPFEN – European Network Parenthood FederationIPPFEN – European Network Parenthood Federation

IUHPE – International Union for Health Promotion and EducationIUHPE – International Union for Health Promotion and Education

MHE-SME – Mental Health Europe-Santé Mentale EuropeMHE-SME – Mental Health Europe-Santé Mentale Europe

PCN – Standing Committee of NursesPCN – Standing Committee of Nurses

PGEU – Pharmaceutical Group of European UnionPGEU – Pharmaceutical Group of European Union

Red Cross/EURed Cross/EU

UEHP-CEHP – European Union of Private Hospitals- (approved UEHP-CEHP – European Union of Private Hospitals- (approved with specific reservation -see: with specific reservation -see: http://forum.europa.eu.int/Public/irc/sanco/ehf/library) http://forum.europa.eu.int/Public/irc/sanco/ehf/library)

UEMS-EUMS – European Union of Medical SpecialistsUEMS-EUMS – European Union of Medical Specialists

Youth Forum JeunesseYouth Forum Jeunesse

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Conclusions

Any initiative at EU level should take due Any initiative at EU level should take due account of the specific features of the account of the specific features of the

health services and adequate consultation health services and adequate consultation with stakeholders and a proper impact with stakeholders and a proper impact assessment should be carried out in assessment should be carried out in

advanceadvance

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Thank you!