Same diseases, different prescriptions

The EU today is host to 27 different national healthcare systems, but the same health problems threaten all 500 million Europeans across the Union.

Healthcare remains the jealous preserve of national governments, not least because health budgets make up a substantial part of public spending. National pride, distrust of the cost of re-organisation and fears about the budgetary implications have obstructed attempts to develop a uniform approach to healthcare.

But greater co-operation on healthcare has been a consequence of increasing European integration, with the Maastricht and Amsterdam treaties of the 1990s giving greater powers on health to the EU. The European Commission can now promote health protection and propose ‘veterinary and phytosanitary’ policies to protect human health.

The increasing numbers of EU citizens travelling and working abroad have necessitated more co-operation but integration is far from complete. Europeans are now far more likely to spend holidays outside their home country than they were when the European Coal and Steel Community (ECSC) was established in 1951, but they still struggle to get a refund for seeing a doctor during trips abroad. Many EU graduates consider which EU country they would like to work in as seriously as what job would best suit them, but travelling to a better equipped hospital within the EU poses serious administrative and legal questions.

The national governments closed off one suggested solution in 2006 when they excluded health services from the remit of the services directive, objecting that healthcare could not be treated in the same way as property and advertising.

Health Commissioner Markos Kyprianou is now in the process of drafting a new EU health strategy to address the gap left in the services directive.

A broad presentation of the strategy’s aims in Parliament last month raised a host of questions from worried MEPs. Representatives from new member states said that something should be done to stop all their best medical workers emigrating to better salaries in western Europe. MEPs from old member states complained that their patients were flying to eastern Europe for cheaper healthcare.

An EU health programme to cover 2007-13 was proposed in 2005 and would provide a central core of project funding for a health strategy. It too has run into difficulties.

The Commission originally proposed combining health and consumer protection in one programme but Parliament and national ministers said that this would confuse things.

When a smaller EU 2007-13 budget than that proposed by the Commission was agreed in December 2005, money allocated for the health programme fell from €969 million to €365.6m.

Three months into the planned first year of the programme, governments and MEPs are still a long way from agreeing a common position.

While political arguments drag out every formal proposal for EU-level action, the Commission has turned to other, softer healthcare options. David Byrne, the then health commissioner, made an anti-smoking campaign a publicity highlight of his time in Brussels. His successor Kyprianou has vowed to carry on in a similar vein.

The Commission is trying to encourage voluntary marketing and social changes through ‘platform’ groups of interested parties, from industry to non-governmental organisations. Kyprianou has already hailed the physical activity and health platform as a success. The problems of obesity and smoking-related diseases are common across the EU, even if the healthcare services that must cope with them remain defiantly different.

The EU today is host to 27 different national healthcare systems, but the same health problems threaten all 500 million Europeans across the Union.