Congress report - European Health Forum Gastein

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158 European Health Forum Gastein 2001 The year 2000 saw the creation of a Franco-Belgian regional Health (OFBS) watchdog in the Hainaut (B) and Nord Pas-de-Calais (F) geographical area. In 2001 this latter has been extended to cover the Luxembourg (B) and Champagne – Ardennes (FR) area. 7. Conclusions. On the basis of an analysis of the various projects, we have been able to show that there is a not inconsiderable potential demand for cross-border care in the Euregion areas and therefore a high level of intentional mobility. This demand corresponds to a real need among the populations involved but is conditioned by a large number of parameters deriving from the characteristics of such populations and from the health infrastructure specific to each region. Taken separately, these factors do not have any impact, and this conveys an image of a highly complex cross-regional mobility in relation to health care, although it also ensures that each Euregion is unique. These Euregions are therefore becoming partners in the search for appropriate solutions in the light of populations' needs and in accordance with existing health care capacity. We can therefore reject the argument which is regularly put forward regarding the risk of destabilisation of the organisation of health services due to uncontrollable movements of citizens, especially because, on the one hand, such intentional mobility continues to be supervised by the partners from the legal and institutional point of view and, on the other hand, the geographical and attraction area is limited. This kind of mobility should be accompanied by a wider process providing the inhabitants of these regions with information. The Euregion projects should receive greater support from the European authorities. A complete listing of all cross-border initiatives should be drawn up, a survey of Euregion infrastructure should be carried out, and a profile of the populations involved should be drawn up. This process of capitalising on information would allow a specific programme of action to be drawn up so as to allow the development of cross-border health projects. As for the revision of Regulation 1408/71, it could benefit from the work and the practical results obtained by the carrying out of the experiments and offer new perspectives in the health field because it is no longer a matter of providing a regulatory framework for the mobility of workers but also for the mobility of citizens. Presentation slides are available for download at the EHFG web-site http://www.ehfg.org/website01/abstracts.htm The SEM and health care – policy conclusions from the EHMA project Reinhard Busse 1. Context and overall significance In political terms, there appears to be a contradiction between the purpose of the Single European Market (SEM) and the manner in which statements in article 152 of the Treaty Establishing the European Community are widely interpreted (“… excluding any harmonisation of the laws and regulations of the Member States. … Community action in the 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
Forum III: Health and the Single European Market field of public health shall fully respect the responsibilities of the Member States for the organisation and delivery of health services and medical care.”). This study investigated the impact of SEM Regulations and Directives as well as respective European Court of Justice (ECJ) rulings – taken together as “interventions” – on the health services of the Member States. It demonstrates that the relationship between health services as a major sector of Member States’ economies and the SEM are intertwined in such a complex manner that it is virtually impossible to separate them. The argument, therefore, that subsidiarity applies to health services is not fully sustainable within the context of the SEM. Thus, the SEM may rightfully be seen as a challenge for health services, adding a further complexity to the principal driving forces such as changing healthcare needs, increasing patient expectations, the development of e-health, a regionalization of political decision making in a context of economic globalization. This is particularly true because the SEM inevitably regards the patient as an individual consumer rather than as a citizen with collective rights and responsibilities. 2. Markets and the European social model At a European level, the SEM requires health services to adapt to market rules, while at national level, governments seek to adapt market rules to ensure the effective delivery of health services within a social model. Differing views on the future structure of health services in Europe underlie much of the debate on health in Europe. These differences are based on two principal, divergent models – the European social model and market forces. SEM Regulations and Directives, while stressing the market, have not been exclusively aimed at achieving economic objectives – indeed some SEM interventions have a social purpose in terms of consumer and health protection (such as the Directive on medical devices 93/42/EEC). Some directives are, arguably, even geared to regulating or limiting market forces (for example the Directive on pharmaceutical price control and regulation 89/105/EEC). Nevertheless, there is a need to recognise that market forces and the European social model have differing objectives. There is, however, no option for simply ‘exempting health from the Single European Market’. There may however be significant cases where regulation of the market is required in order to achieve health objectives. Paradoxically, this requires a new coherence and prominence for EU health policy – not just to draw a sustainable rather than accidental line between Member State policy and EU-wide policy, but also to make the aspirations of both these actors more coherent. 3. Intended and unintended effects SEM interventions have both intended effects (principally to create a single market with free movement of goods, services, people and capital) as well as unintended effects. Intended effects include providing the basis for a range of European activities in healthcare, e.g. a common public procurement system for goods and services, Europe-wide mobility of doctors and nurses, a common system for regulating medical devices, common licensing and market access procedure for pharmaceuticals as well as a European system to provide health 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 159
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Organiser: International Forum Gast
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The International Forum Gastein gra
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Co-organisers Sponsors
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8 European Health Forum Gastein 200
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12 Preface David Byrne European Hea
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16 Günther Leiner European Health
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Inserat A1
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34 Investing in Better Health in Wa
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74 Luigi Bertinato European Health
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84 Key Issues There are a number of
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104 Identifying EEA Doctors and Nur
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106 Figure 3: Nurses registered wit
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214 Summary Report of Forum V Stipe
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238 Main features of this database:
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242 DRAFT GUIDELINES ON QUALITY CRI
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244 Petra Wilson Statement not avai
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Inserat DaMe
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276 Final Programme 2001 Programme
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278 Friday, September 28th , 2001 0
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280 Forum II: Globalisation, World
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308 Ms. Regina Sauto Information an
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Congress report - European Health Forum Gastein

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