Congress report - European Health Forum Gastein

Forum III: Health and the Single European Market
problematic and contingent upon specific structural and cultural conditions. An argument
could be made for the development of a minimum competency framework to be adopted
across the EU.
The (implicit) assertion underlying the EU legislative framework is that labour mobility is ‘a
good thing’. Clearly, in an economically and socially homogeneous Europe, which is a supernational
political entity, such mobility is likely to be considered as a basic human freedom.
This study highlights the positive aspects of mobility which are both at the individual level in
terms of widening experiences and opportunities, and at the institutional level where
organisations are enriched through a wider range of cultural and educational inputs.
Yet, in a Europe ‘at the crossroads’, there may be unpredictable effects upon individual
countries. If, for example, doctors are in shortage Europe-wide or in certain economically
better-off countries, then free mobility may lead to shortages in economically poorer
countries. The migration of doctors from Greece to the UK would be a case in point. The
situation could be the other way round: surpluses in better-off countries could aid poorer
countries, or countries with shortages, or both. The recent (only temporary) surplus of
German doctors is a case in point.
What is clear, however, is that national manpower planning in the public sector may often be
inadequate to achieve its goals in the context of unpredictable international mobility. As a
result, there may be a politically difficult choice to be made between developing a European
manpower planning strategy for substantially publicly funded provision (e.g. of doctors); the
maintenance or even increase in regulatory restrictions on mobility to prevent national
strategies for being undermined; and the increasing privatisation of public planning (e.g.
leaving the supply of doctors to the private market with individuals investing in their own
training). The last is likely to be unattractive and inequitable – for poorer individuals and
also poorer countries. The second option goes against the grain of developing EU policy. Yet,
the first option is an attack upon subsidiarity within the EU as currently understood.
This overview on four EU countries has not begun to investigate these matters in any depth.
Yet, the pervasiveness of ‘informal’ barriers to implementation of free mobility perhaps
suggests that – in the absence of clear European policy compatible with member states’ own
policy and reality – member states will use informal policy, or barriers, to render national and
EU directives superficially compatible.
Presentation slides are available for download at the EHFG web-site
http://www.ehfg.org/website01/abstracts.htm
References
Buchan, J., Seccombe, I. and Ball, J. (1992) The International Mobility of Nurses, A UK
Perspective. 230, Institute of Manpower Studies.
Buchan, J. (1998) Your Country Needs You. Health Service Journal 22-25.
Buchan, J. (2000) Pressure is on, Health Service Journal, 26-27.
Davies.J. (2000) The devil is in the detail, Health Service Journal, June 1, 18-21.
European Commission (1996) Education, training, research. The obstacles to transnational
mobility, Brussels, COM(96)462 final.
European Observatory on Health Care Systems (2000) Health care systems in transition –
Germany, written by R. Busse. Copenhagen: European Observatory on Health Care
Systems (in print)
International Forum Gastein, Tauernplatz 1, A-5630 Bad Hofgastein
Tel.: +43 (6432) 7110-70, Fax: Ext. 71, e-mail: info@ehfg.org, website: www.ehfg.org
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