Better EU healthcare begins at home

Two MEPs discuss healthcare and the EU

Kathy Sinnott

Europe has little to say about hospital waiting lists in my member state, Ireland. Irish patient complaints to the European Commission will generally be returned to sender with a recommendation that the complaint be taken to the national government. Despite this, Europe has a significant affect on health in Ireland.

Although health is not presently a ‘competence’ of the European Union except in very specific circumstances, Europe is playing an increasing role in our national health policy. The European mobilisation in the face of a possible avian flu epidemic is a function of the European Centre for Disease Prevention and Control (ECDC) and one of the first challenges taken up by this fledgling agency.

In theory, a government could choose to let EU membership transform its health system. EU structural funds can be used for social infrastructure and can be used to build necessary health and medical infrastructure. But regions eligible for structural funds have largely chosen to spend most of the money on projects with more of a direct commercial rather than social value.

The role the EU plays in health tends to stem from European competencies such as environment, consumer protection, employment and industry.

From these other competencies, the European Commission proposes many regulations and directives that have direct application to people’s health, such as legislation to end mercury mining in Europe.

It does not take you long as an MEP to learn to put people issues in economic terms in order to advance them. In my report on the prevention of injury and promotion of safety for the committee on environment, public health and food safety, I have had to include the economics and the financial burden of injury, while also including as much human consideration as I think will get through the legislative process.

Research is one of the main ways that ‘European added value’ is achieved in health. Though the data ultimately comes from the individual member state, Europe plays a role in gathering the information, ensuring that it is comparable. To this end, there is a trend towards harmonising definitions and criteria and developing systems for accumulating the data.

We are all frustrated by the fact that only the Commission can initiate legislation. We, as members of Parliament, have had to wait passively for the Commission to wake up to an area of concern to constituents and then decide that it merited European action. I noticed that the Commission responded best to its own research, so applying for Commission-funded research seemed to be an effective way of catching the Commission’s attention. The strategy seems to work. At present I am involved in a project about rescuing people with disabilities in an emergency. This draws together many strands of EU concern, such as equality, ageing, flooding, terrorism, climate change and preparedness or lack of it. In the project, we can focus the EU to ensure that, in a chaotic time, chaos does not take over.

Despite being an MEP who is working within the European institutions to get better healthcare and ultimately better health for my constituents, I do not want Europe to take over healthcare. The nearer we can bring health policy decision-making to people the better healthcare will be. Do you think that the cancer services in Waterford would be lacking if the people of Waterford and the local health authorities had a real say?

The combination of EU strategies and local subsidiarity is key to improving healthcare by making it more directed and more committed. People need to be able to have a personal stake in their services. A study presented to us in Brussels showed that the countries with the most centralised health systems had the most patient dissatisfaction and longer waiting lists and vice versa. Pride of place went to Switzerland which has 23 independent health systems, one per canton, and a satisfied patient population.

• Irish Independence and Democracy MEP Kathy Sinnott is a member of the committee on the environment, public health and food safety.

Françoise Grossetête

Health, along with other social issues, was not one of the priorities of the Treaty of Rome. That is why the involvement of the European community in the field of health did not materialise until the 1980s on the occasion of the implementation of the broad economic principles written in the founding treaties. That is also the case for regulations 1408/71 and 574/72 dealing with the co-ordination of social security regimes, or the many directives dealing with healthcare professionals adopted in order to ensure the free movement of persons. The Single European Act followed by the Treaty of Maastricht and finally the Treaty of Amsterdam developed in succession the principles and objectives of Community intervention in the health field. A treaty article dedicated to public health states that "a high level of protection of human health should be assured in the definition and implementation of all Community policies and actions" (Article 152, Treaty on the European Union).

But the EU’s action in the field of health remains limited and the Union will only intervene, according to the principle of subsidiarity, if actions at Community level are more effective than those carried out at national level. In fact, the EU’s intervention is essentially limited to encouraging and facilitating co-operation among member states on public health matters. Yet, if the EU only intervenes at the margins on heath issues, it remains an integrated space within which, under certain conditions, the principle of the free movement of patients, of healthcare professionals and health services should apply.

This is how regulations have been put in place to co-ordinate social security regimes. These regulations allow a person who needs medical treatment - staying in a member state other than their own - to be reimbursed on presentation of the European sickness insurance card (which replaced the E111 form in 2004). The healthcare services are to be provided on the basis of the system in place in the country where the medical services are being provided, on condition that there is prior authorisation for the medical services. At the same time, free movement for medical professionals has been guaranteed by putting in place - through a dozen sectoral directives which were subsequently consolidated in directive 2005/36/EC - a system for recognising professional qualifications, so making it easier for healthcare professional to establish themselves and provide services.

But even though there is a legal framework designed to ensure free movement, the mobility of patients and healthcare professionals remains relatively marginal. This is particularly true for patient mobility. This should in no event be allowed to lead to dumping among healthcare systems or to a deterioration of safety. Healthcare is not a service like any other. It would be irresponsible to try to introduce competition in healthcare services. This is also true for the safety and equality of access to care. A good response to the increasing mobility of patients is also to improve healthcare services in each member state. On this point, there should be a better application of the transparency directive (89/105/EEC) to promote European pricing for medicines and to encourage more strongly the use of a centralised authorisation procedure for putting medicines on the market. There should also be an early study in order to establish precisely at which sections of the public the mobility of healthcare services is aimed. This study would help to predict the extent of this mobility and to take it more into account in member states’ national social budgets. Better understanding of patient mobility will also make it possible to have a more appropriate legal response to the issue. Information exchanges between healthcare professionals should be improved to establish a more secure framework for patients and healthcare professionals. These harmonised indicators should also make it possible to make savings on healthcare expenditure.

This is my vision for healthcare services in order to ensure a more uniform application within the EU’s borders. Healthcare services are special services. It is essential to prevent any drift towards medical tourism, a trend which is becoming more and more widespread.

• French centre-right MEP Françoise Grossetête is a member of the European Parliament’s committee on the environment, public health and food safety.

Two MEPs discuss healthcare and the EU