Congress report - European Health Forum Gastein

Forum III: Health and the Single European Market
On 29 August 1947, the Netherlands and Belgium signed a Convention "on the application of
their reciprocal social security coverage legislation". Two agreements were later concluded in
1957 and 1965 concerning social security coverage in respect of sickness expenses. To the
extent that they related to benefits, these agreements ceased to apply on 1 January 1981
because of the entry into force of the agreement of 24 December 1980 on the coverage of
medical care.
In addition, Article 51 of the 1958 Treaty of Rome granting the Council the power to adopt
"such measures in the field of social security as may be necessary to provide freedom of
movement for workers" and which were introduced by Regulation 1408/71 did not do away
with the bilateral contractual arrangements. These have progressed by providing better
coverage and easier access to care.
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• The Grand Duchy of Luxembourg, in an effort to simplify the administrative
procedures for reimbursement of its costs, has entered into agreements with
medical establishments in the surrounding countries. Seven agreements have been
signed with different German university hospitals, including two in Trier. These
hospitals bill the Luxembourg health insurance funds directly for treatment provided
to Luxembourg patients.
• The Belgian-Luxembourg Convention concluded on 24 March 1994, replacing the
one dated 16 December 1959. Any frontier worker and members of his family
receiving benefits in kind on Belgian territory are entitled, where necessary, to an
additional reimbursement under Luxembourg legislation. This additional
reimbursement is payable by the competent Luxembourg institution.
At European level the introduction of the coordination Regulations 1408/71 and 574/72 has in
no way restricted the room for manoeuvre by Member States, especially through the entering
into of bilateral agreements. However, there has been a gradual weakening of this instrument
for coordinating social security schemes which, on the one hand, was drawn up for the
purpose of guaranteeing rights to migrant workers and their dependants and which, on the
other hand, was subsequently extended18 . On the one hand, it contains inherently restrictive
elements whereas, on the other hand, European integration has resulted in changing the
principle of freedom of movement for persons from an economic right to a personal right of
European citizens.
This weakening is all the more noticeable as Member States continue to claim a sovereign
competence as regards organising health and social protection by invoking, on the one hand,
Article 5 of the Treaty which defines the principle of subsidiarity and, on the other hand,
Article 152 (5) of the Treaty which provides that "Community action in the field of public
health shall fully respect the responsibilities of the Member States for the organisation and
delivery of health services and medical care". In fact, Regulations 1408/71 and 574/72 do not
rule out the principle of territoriality and their objective is not to ensure merely access to
health care for citizens in other Member States.
18 Article 51 of the Treaty of Rome entrusted the Council of Ministers of the European Economic
Community with the task of adopting "such measures in the field of social security as may be
necessary in order to provide freedom of movement for workers". The Council of Ministers first
adopted:
- Regulations (Nos. 3 and 4) covering social security for migrant workers;
- Regulations (Nos. 36/63 and 73/63) covering social security for frontier workers;
- Subsequently, the Regulations (1408/71 and 574/72) on the application of social security schemes to
employed persons and their families [foreign nationals from one of the Member States, refugees and
stateless people) moving within the Community