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The Influence of the European Union

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Abstract

According to the Maastricht Treaty of 1992, health care in the countries of the European Union is, together with social security, subject to the princi- ple of subsidiarity, which implies that each member state is free to choose its own organizational and financial arrangements regarding the production and consumption of health care goods and services. Nevertheless, the internal market requires that EU citizens be provided a level of health services of a certain quality in accordance with professional norms. Articles 152 and 153 of the Maastricht Treaty, as well as EU agreements regarding the protection of human rights, are (also) meant to enforce this requirement. My argument in this chapter is that, as a result of ongoing European economic integration, the subsidiarity principle will be slowly eroded with respect to health care, because continued collective financing of health care will encounter problems similar to those resulting from the attempts to combine economic objectives with objectives of social policy regarding social security. In other words, though individual member states may want to administer their health care systems without restriction, this will become increasingly difficult as a consequence of ongoing economic integration;and thus the principle of solidarity in health care will be effected. Looking at the developments since 1975, we may conclude that, despite the subsidiarity principle, the European Commission is slowly taking the lead in getting control of the financial aspects of health care. Though the Commission’s role, in this respect, still seems mainly to be assisting the member states, a more directive role should not be excluded, if it were only because the member states’ governments, taking into account their constitutional obligations, are very much interested in an optimal balance between the costs and bene its of their health care systems.I will deal with this influence of the European Union in the second section of this chapter, whereas the third section will go into some adjustment problems following from the EU’s enlargement of 2004. Before doing so I will address in the first section the difficulties one encounters when attempting to compare health care systems.

Keywords

Member State Health Care System National Health Service Maastricht Treaty Individual Member State 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

Chapter 7

  1. 1.
    Roscam Abbing, H. D. C.: Wetgeving binnen de Europese Unie, in: Lens, P. and Kahn, Ph. S., (eds.): ibid., pp. 67–81.Google Scholar
  2. 2.
    Dubois, C.-A. and McKee, M.: Health and Health Care in the Candidate Countries to the European Union: Common Challenges, Different Circumstances, Diverse Policies, in: McKee, M., MacLahose, L., Nolte, E., (eds.): ibid., p. 45.Google Scholar
  3. 3.
    Field, in: Krukemayer, H.: Vergleichende Systemanalyse des Krankenhauswesens in OECD-Ländern, Bremen, 1985, p. 30.Google Scholar
  4. 4.
    OECD: The Reform of Health Care: A Comparative Analyses of Seven OECD Countries, Health Policy Studies, No. 2, Paris, 1992, pp. 19–29.Google Scholar
  5. 5.
    In: Materne, L., et al.: ibid.Google Scholar
  6. 6.
    For example Groot, L. M. J., in: Stocking, B., (ed.): ibid., chapter 1.Google Scholar
  7. 7.
    Dent, M.: Remodelling Hospitals and Health Professions in Europe: Medicine, Nursing and the State, Palgrave, 2003, p. 85.Google Scholar
  8. 8.
    Commissie van de Europese Gemeenschappen: Mededeling van de Commissie aan de Raad, het Europees Parlement, het Economisch en Sociaal Comité en het Comité van de Regio’s. De Toekomst van de Gezondheidszorg en de Ouderenzorg: de Toegankelijkheid, de Kwaliteit en de Betaalbaarheid waarborgen, COM(2001) 723 definitief, Brussels, 5 December 2001, p. 11.Google Scholar
  9. 9.
    Appleby, J.: Financing Health Care in the 1990s, Open University Press, 1993, pp. 46–47.Google Scholar
  10. 10.
    For the different methods of financing health care, see: Mossialos E., Dixon, A., Figueras, J., Kutzin, J., (eds.): ibid.Google Scholar
  11. 11.
    Fattore, G.: Cost Containment and Reforms in the Italian National Health Service, in: Mossialos, E. and Le Grand, J., (eds.): ibid., p. 513.Google Scholar
  12. 12.
    European Parliament, Directorate General for Research: Health Care Systems in the EU: A Comparative Study, Working Paper, Public Health and Consumer Protection Series, SACO 101/rev. EN, November 1998, p. 5.Google Scholar
  13. 13.
    Illustrative for the staggering differences is the first chapter of Mossialos and Le Grand’s Health Care and Cost Containment in the European Union (Mossialos, E. and Le Grand, J., (eds.): ibid., chapter 1).Google Scholar
  14. 14.
    In this respect, see: Saltman, R. B., Busse, R., Figueras, J., (eds.): ibid.Google Scholar
  15. 15.
    Jakubowski, E. and Hess, R.: The Market for Physicians, in: McKee, M., MacLehose, L., Nolte, E., (eds.), ibid., p. 141.Google Scholar
  16. 16.
    Saltman, R. B. and Figueras, J.: ibid., p. 9.Google Scholar
  17. 17.
    Theofilatou, M. A.: ibid., p. 174.Google Scholar
  18. 18.
    Commission of the European Communities: Report from the Commission to the Council, the European Parliament and the Economic and Social Committee on the Integration of Health Protection Requirements in Community Policies, COM (95) 196 final, Brussels, 29 May 1995.Google Scholar
  19. 19.
    In this respect, the Commission’s 1993 Green Paper on European Policy reveals that 8,000 Europeans die annually due to accidents at their work place. Throughout the Community, 10 million workers suffer an industrial accident or occupational disease every year (Commission of the European Communities. Directorate-General for Employment, Industrial Relations and Social Affairs: European Social Policy: Options for the Union, Green Paper, COM (93) 551, Brussels, 17 November 1993, p. 65).Google Scholar
  20. 20.
    European Commission: The Internal Market and Health Services. Report of the High Level Committee on Health, 17 December 2001, p. 19).Google Scholar
  21. 21.
    European Health Management Association: The European Union and Health Services—The Impact of the Single European Market on Member States; Summary of a Report to the European Commission’s Directorate General for Research, Dublin, May 2001, p. 7. EHMA’s report was part of the European Commission’s BIOMED2 program. It identified 233 regulations, directives, decisions, recommendations, and ECJ rulings issued between 1958 and 1988 which had the potential to affect member states’ health systems. Of these regulations, almost two-thirds emanated from political decision-making and more than one-third from rulings of the European Court of Justice.Google Scholar
  22. 22.
    Marinker, M., (ed.): Health Targets in Europe: Polity, Progress and Promise, BMJ Books, 2002.Google Scholar
  23. 23.
    Commissie van de Europese Gemeenschappen: Kostenbewaking bij de Planning en Organisatie van de Gezondheidszorg. Werkdocument van de Commissie, COM (84) 1652 def., Brussels, 25 October 1984, p. 1.Google Scholar
  24. 24.
    Commissie van de Europese Gemeenschappen: Communautaire Samenwerking op het Gebied van de Volksgezondheid. Mededeling van de Commissie aan de Raad, COM(84) 502 def., Brussels, 18 September 1984, p. 11.Google Scholar
  25. 25.
    European Parliament, Directorate General for Research: Health Care Systems in the EU: A Comparative Study, Working Paper, Public Health and Consumer Protection Series, ibid., p. 5.Google Scholar
  26. 26.
    Commission of the European Communities: Commission Communication on the Framework for Action in the Field of Public Health, COM (93) 559 final, Brussels, 24 November 1993, p. 4.Google Scholar
  27. 27.
    Commission of the European Communities: Commission Communication on the Framework for Action in the Field of Public Health, ibid., p. 14.Google Scholar
  28. 28.
    Commission of the European Communities: Report from the Commission to the Council, the European Parliament and the Economic and Social Committee on the Integration of Health Protection Requirements in Community Policies, ibid., pp. 21–24.Google Scholar
  29. 29.
    Commission of the European Communities: Report from the Commission to the Council, the European Parliament and the Economic and Social Committee on the Integration of Health Protection Requirements in Community Policies, ibid., p. 35.Google Scholar
  30. 30.
    Commission of the European Communities: Communication from the Commission concerning a Community Action Programme on Health Monitoring in the Context of the Framework for Action in the Field of Public Health, COM(95) 449 final, Brussels, 16 October 1995.Google Scholar
  31. 31.
    Commission of the European Communities: The Future of Social Protection: A Framework for a European Debate. Communication from the Commission, COM (95) 466 final, Brussels, 31 October 1995, p. 12.Google Scholar
  32. 32.
    Commissie van de Europese Gemeenschappen: Mededeling van de Commissie. Modernisering en Verbetering van de Sociale Bescherming in de Europese Unie, COM(97) 102 def., Brussels, 12 March 1997, p. 25.Google Scholar
  33. 33.
    Commission of the European Communities: Communication from the Commission to the Council, the European Parliament, the Economic and Social Committee and the Committee of the Regions on the Health Strategy of the European Community. Proposal for a Decision of the European Parliament and of the Council adopting a Programme of Community Action in the Field of Public Health (2001–2006), ibid. (2000) 285 final, Brussels, 16 May 2000, pp. 2, 3, 8, 10, 11.Google Scholar
  34. 34.
    European Parliament: Texts adopted at the Sitting of Thursday, 16 November 2000, provisional edition PE 297.763.Google Scholar
  35. 35.
    Commissie van de Europese Gemeenschappen: Mededeling van de Commissie aan de Raad, het Europees Parlement, het Economisch en Sociaal Comité en het Comité van de Regio’s. De Toekomst van de Gezondheidszorg en de Ouderenzorg: de Toegankelijkheid, de Kwaliteit en de Betaalbaarheid waarborgen, ibid., p. 12.Google Scholar
  36. 36.
    McKee, M., Rosenmöller, M., MacLehose, L. and Zajac, M.: The Process of Enlargement, in: McKee, M., MacLehose, L., Nolte, E., (eds.): ibid., p. 14.Google Scholar
  37. 37.
    European Commission, Health & Consumer Protection Directorate-General: The Internal Market and Health Services. Report of the High Level Committee on Health, 17.12.2001, pp. 25–26.Google Scholar
  38. 38.
    Byrne, D.: The European Role in Patient Mobility, in: Free Movement and Cross-Border Cooperation in Europe: The Role of Hospitals and Practical Experiences in Hospitals, ibid., p. 29.Google Scholar
  39. 40.
    Schemken, H-W.: Cross-Border Cooperation and Free Movement of Patients: the Point of View of the Financial Bodies, in: Free Movement and Cross-Border Cooperation in Europe: The Role of Hospitals and Practical Experiences in Hospitals, ibid., p. 73.Google Scholar
  40. 41.
    Dehaye, J. C.: Interreg III Projects: French-Belgian Health Observatory (O.F.B.S.), Wallonia, Lorraine, Luxumbourg EEIG Luxlorsan, in: Free Movement and Cross-Border Cooperation in Europe: The Role of Hospitals and Practical Experiences in Hospitals, ibid., p. 93.Google Scholar
  41. 42.
    European Commission: High Level Process of Reflection on Patient Mobility and Healthcare Developments in the European Union, p. 4. The public health programme was adopted by the European Parliament and the Council of Ministers on the 23 September 2002 with the following general objectives (a) health information, (b) rapid reaction to health threats, and (c) health promotion.Google Scholar
  42. 43.
    In this respect, see: Theofilatou, M. A.: ibid., p. 28.Google Scholar
  43. 44.
    Gibis, B., Koch-Wulkan, P., and Bultman, J.: Shifting Criteria for Benefit Decisions in Social Health Insurance Systems, in: Saltman, R.B., Busse, R., Figueras, J., (eds.), ibid., p. 198.Google Scholar
  44. 45.
    McKee, M., MacLehose, L., and Albreht, T.: Free Movement of Patients, in: McKee, M., MacLehose, L., Nolte, E. (eds.), ibid., p. 168.Google Scholar
  45. 46.
    See: Standing Committee of the Hospitals of the European Union (HOPE): Hospitals and Emergency Care in the European Union, Leuven, undated.Google Scholar
  46. 47.
    Hermans, B. and Brouwer, W.: Quality Issues on Cross-border Care: A Literature Search, Rotterdam/Utrecht, June 2003, p. 43, www.ehma.org.Google Scholar
  47. 48.
    Zajac, M.: Free Movement of Health Professionals: The Polish Experience, in: McKee, M., MacLehose, L., Nolte, E., (eds.), ibid., p. 119.Google Scholar
  48. 51.
    Harant, Ph.: Hospital Cooperation in Border Regions in Europe, in: Free Movement and Cross-Border Cooperation in Europe: The Role of Hospitals and Practical Experiences in Hospitals, Proceeding of the HOPE Conference and Workshop, Luxembourg, June 2003, pp. 34–37.Google Scholar
  49. 52.
    Next to this, Hermans and Brouwer identify a number of problems which may seriously obstruct cross-border relations. They are (a) lack of funding, (b) lack of consistency and compatibility between different EU funding programs, (c) differences in administrative competences, (d) different tiers of government, (e) lack of experience, as well as language barriers and low prioritizing by authorities. In: Hermans, H. E. G. M. and Brouwer, W.: ibid., p. 83.Google Scholar
  50. 53.
    Scheres, J.: Cross-Border Health Care in the EU Region Meuse-Rhine: Pilot for Europe? in: Free Movement and Cross-Border Cooperation in Europe: The Role of Hospitals and Practical Experiences, ibid., pp. 40–42.Google Scholar
  51. 54.
    Weirauch, B.: Cross-Border Cooperation and Free Choice of Health Care for Patients from Various Viewpoints, in: Free Movement and Cross-Border Cooperation in Europe: the Role of Hospitals and Practical Experiences in Hospitals, ibid., p. 59.Google Scholar
  52. 55.
    NVZ nieuws, jaargang 2003, No. 15, 16 April 2003.Google Scholar
  53. 56.
    An excellent overview of the health policy problems which have to be dealt with as a consequence of enlargement has been provided by McKee et al. (McKee, M., MacLehose, L., Nolte, E., (eds.): ibid.).Google Scholar
  54. 57.
    McKee, M., Rosenmöller, M., and Zajac, M.: ibid., p. 8.Google Scholar
  55. 58.
    McKee, M., Adany, R., and MacLehose, L.: Health Status and Trends in Candidate Countries, in: McKee, M., MacLehose, L., Nolte, E., (eds.): ibid., chapter 3.Google Scholar
  56. 59.
    McKee, M., Rosenmöller, M., MacLehose, L., and Zajac, M.: ibid., pp. 14–17.Google Scholar
  57. 60.
    McKee, M., Rosenmöller, M., MacLehose, L., and Zajac, M.: ibid., pp. 19–20.Google Scholar
  58. 61.
    Wright-Reid, A., McKee, M., and MacLehose, L.: Closing the Gap: Health and Safety, in: McKee, M., MacLehose, L., Nolte, E., (eds.): ibid., p. 180. In this respect, the World Bank estimates that two-thirds “of occupationally determined loss of healthy life years could be prevented by occupational health and safety programmes” (Wright-Reid, A., McKee, M., and MacLehose, L.: ibid., p. 180).Google Scholar
  59. 62.
    MacLehose, L., Coker, R., and McKee, M.: Communicable Disease Control: Detecting and Managing Communicable Disease Outbreaks across Borders, in: McKee. M., MacLehose, L., Nolte, E., (eds.): ibid., chapter 13.Google Scholar
  60. 63.
    Gilmore, A. B., Österberg, E., Heloma, A., Zatonski, W., Delcheva, E., and McKee, M.: Free Trade versus the Protection of Health: The Examples of Alcohol and Tobacco, in: McKee, M., MacLehose, L., Nolte, E., (eds.): ibid., p. 220.Google Scholar
  61. 64.
    Kanavos, P.: European Pharmaceutical Policy and Implications for Current Member States and Candidate Countries, in: McKee, M., MacLehose, L., Nolte, E., (eds.): ibid., pp. 240–264.Google Scholar
  62. 65.
    Hofmarcher, M.M. and Durand-Zaleski, I.: Contracting and Paying Providers in Social Health Insurance Systems in: Saltman, R. B., Busse, R., Figueras, J., (eds.): ibid., p. 220.Google Scholar
  63. 66.
    See: (1) Nicholas, S.: The Challenges of the Free Movement of Health Professionals; (2) Zajac, M.: ibid., and (3) Jakubowski, E. and Hess, R.: ibid. All three papers can be found in: McKee, M., MacLehose, L., Nolte, E., (eds.), ibid., chapters 7, 8, and 9.Google Scholar
  64. 67.
    McKee, M., MacLehose, L., and Albreht, T.: ibid., p. 169, table 11.1.Google Scholar
  65. 68.
    Dubois, C.-A. and McKee, M.: Health and Health Care in the Candidate Countries to the European Union: Common Challenges, Different Circumstances, Diverse Policies, in: McKee, M., MacLehorse, L., Nolte, E., (eds.): ibid., chapter 4.Google Scholar
  66. 69.
    Dubois, C.-A. and McKee, M.: ibid., p. 49.Google Scholar
  67. 70.
    Kanavos, P.: ibid., p. 261.Google Scholar

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