Brussels, 09-10 October 2002
{{1. Current landscape: health care systems in the European Union and the candidate countries are increasingly affected by policies carried out at European level
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} }}1.1. Although health care systems are considered as a national competence, especially as regards their organisation and financing, they are increasingly affected by “European policies”.
1.2. It is not our intention to review all European policies having an impact on health care systems, however we wish to underscore the following points:
1.2.1. The emphasis placed on the need to control public spending in the Broad Economic Policy Guidelines inevitably has an impact on the health policies pursued in the different States (for example, measures intended to control health costs and “rationalise” resources).
1.2.2. Health systems are not immune from the Internal Market rules. In this regard, as the European Court of Justice has constantly reasserted, health care services are covered by the principle of the "Free Provision of Services", one of the European Union's four fundamental freedoms. This also has consequences for the mobility of patients, and on the future financing and organisation of health care services.
1.2.3. Following national reforms introducing market mechanisms, there is a risk of health care services falling within the scope of Community economic law. As a consequence we see, that drawing and redrawing the fine line between ‘economic ‘ and ‘solidarity' activity is what much of the legal conflicts and ECJ judgments are about. In addition, privatisation facilitates the creation of a European health services market which multinationals in the sector attempt to dominate.
1.2.4. Likewise, pharmaceutical policy, which falls within the scope of industrial policy, aims to improve the sector's competitiveness, based on the diagnosis that Europe lags behind the United States in its capacity to generate, organise and support increasingly burdensome and complex innovation processes. Although there is clearly a need to stimulate innovation and enhance scientific levels, it is also necessary to produce affordable products that are safe, effective and used in a rational way. The current policy tends to readily accept a simple innovation which doesn't always represent therapeutic progress. Hence, the enterprise which launches the product on the market, makes use of its intellectual property rights, which effectively means a higher reimbursement cost than for a generic product. We must not lose sight of the fact that in all the Member States, expenditure on pharmaceutical products has increased more rapidly than the average expenditure in the area of health care. In certain countries, in particular in the accession candidate countries, pharmaceutical products represent a considerable share of the total public health care budget, which holds back investments to satisfy other urgent health care needs.
1.2.5. At the same time, the priority given by the European Union to combating poverty and promoting social inclusion makes access to quality care for all, one of this policy's key strategic elements.
1.2.6. These policy examples which also reveal a certain fragmentation, inevitably have ramifications not only for patients, but also for the health care services themselves and conditions of access. In particular, the internal market rules create tensions between, on the one hand, the competition rules and, consequently, risk selection in the area of health cover and, on the other hand, access for all to quality health care services. However, it should be noted that health care systems are based in Europe on common values of solidarity and universal cover.
{{2. A trade union priority: access for all to quality health care
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} }}2.1. The ETUC and the European Public Sector Unions are not unaware of these challenges and the pressures facing health care systems throughout the European Union and in the candidate countries.
For the ETUC and the EPSU, the priority and objective of any European approach must be access for all to quality health care, which implies initiatives be taken and measures adopted, both nationally and at European level.
2.2. In light of this priority, the ETUC and the EPSU have certain criticisms of the European Commission's Communication entitled ‘the Future of Health Care'. In this communication, the Commission addresses the question of increasing health care expenses, among other things in relation to the ageing of the population, as it does for the pension schemes and related expenses. However, The question isn't that similar. Studies show that, on average, it is in the last year of a person's life that expenditure explodes (in the same way, inversely, in the first years of a person's life) and not because people get older, except for pharmaceutical expenses which are higher for pensioners than for the active population. . Moreover, the approach thus adopted at European level confuses "health" spending strictly speaking for elderly people and "support" spending, related to long-term constant care situations (food, personal hygiene, etc.) which are not of the same nature and do not follow the same financing rules.
In addition, we distinguish the debate on the future of health care from that of situations requiring long-term constant care. Although there is a need for European reflection on the latter issue, this distinction must be made
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3) How to achieve this trade union objective at European level?}}
3.1. The measures taken at European level must not subordinate the social approach to economic and financial imperatives.
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} }}This is particularly important with regard to the Major Economic Policy Guidelines. We should never lose sight of the fact that social protection is a productive factor that contributes to growth and social cohesion.
3.2. Achieving the objective of access for all to quality health services implies the following initiatives:
3.2.1. The ETUC and the EPSU call for Community legislation to be amended and an open method of coordination[[Following the example of employment policy, social inclusion and pensions, the open method of coordination is a process at European level that sets objectives, in this case in the area of health care. This process then requires these objectives to be achieved nationally by allowing the Member States to choose the method: this means that the States draw up plans of action, with the Council and Commission subsequently jointly assessing national achievements. ]] to be adopted in the area of health care.
Legislation: The Treaty
3.2.2. The future Treaty while stating that the funding and organisation of health care remain a member state competence, needs to combine the “acquis” already included in the Treaty, in particular the high level of social protection and a high level of human health, with the right to health included in Charter of Fundamental Rights in view of promoting accessible and financially sustainable health care of high quality organised on the basis of solidarity; .This also means that European policies must measure their impact on national health care systems in order to asset the principle of solidarity ahead of competition, The ETUC and the EPSU will mobilise during the Convention's work in order to have this obligation included in the Treaty.
Directives and regulations, inter alia.
3.2.3.
This obligation implies that new and revised legislation such as the one on services of general interest which must give priority to the principle of solidarity.
An amendment of the directives concerning the recognition of professional qualifications in the health care sector in order to include qualifications acquired by way of further vocational training;
An amendment of the directive on non-life insurance; article 54 currently provides for an exemption for certain types of insurance, that is to say the competition rules can be waived on the basis of the concept of general interest, but this article does not protect sufficiently supplementary insurance in the area of health care based on the principle of solidarity;
An amendment to the sickness and maternity chapter of regulation 1408/71 relative to the application of social security systems to employees, self-employed people and members of their family who travel within the Community. In the light of the judgements handed down by the European Court of Justice, this chapter is now obsolete and creates legal uncertainty; The revision of this chapter should reflect an equilibrium between free movement of persons, financial sustainability of the health care system, and creation of medical centres of expertise;
A new directive on electronic commerce in medicines, in particular regulating direct advertising to consumers. Some advertisements can lead to an inefficient and counter-productive use of medicines.
The open method of co-ordination{
}3.2.4. The implementation of an Open Method of Co-ordination, including the definition of common objectives, determined at national level, the introduction of qualitative and quantitative evaluation indicators and a monitoring and assessment procedure.
The following guidelines result from the priority objective of “access for all to quality health care services”.
3.2.4.1. Guaranteeing the financing of health systems based on solidarity between sick people and people in good health. This means not only that patients should receive the health care required by their condition and not simply according to the extent of their contributory capacity or income, but also that they should contribute according to their means.
3.2.4.2. Implementing, in all the Member States and at European level, an approach based on an assessment of both technological performances and the effectiveness of medical practices, which implies abandoning all practices and medicines which have not proved their relevance and therapeutic effectiveness.
However, the following aspects must be distinguished:
today, there is a European agency which evaluates the effectiveness of new medicines (the European Medicines Evaluation Agency, EMEA); however, it is possible to criticise its lack of transparency and question whether the distinction between therapeutic progress and simple innovation has been truly established;
there are neither tools at European level to evaluate the therapeutic progress of medical equipment nor scientific standards to evaluate medical practices.
In this regard, the ETUC and the EPSU call for greater transparency with regard to the European Medicines Evaluation Agency's decisions, as well as new tools for the purpose of evaluating medical equipment and medical practices
3.2.4.3. Involving the Social Protection Committee in defining the policies to be applied at European level in this area. The social partners must continue to be consulted in the framework of this committee and also be involved in the process at national level.
3.2.4.4. Involving users, that is to say patients, in the definition of health policy objectives and the means necessary for their implementation. A distinction must be made between this and the management of health care systems which, in Bismarckian social security systems, falls within the remit of the social partners in particular.
3.2.4.5{{ {. Ensuring that illegal immigrants are guaranteed access to health care. Today, certain Member States invite the medical authorities to denounce illegal immigrants.
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3.2.4.6 . Favouring preventive actions, including the area of health and safety at work.
The European social dialogue
3.2.5. The ETUC and the EPSU want to be consulted on the subject of new Community legislation having an impact on health care systems.
3.2.6. The EPSU is in favour of a European social dialogue with the employers of the different sub-sectors related to health care services.
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} }}3.2.7. The Commission will favour the development of cooperation between the Member States facilitating access to all hospitals or health centres, from one country to another, following the lead in this area of certain cross-border regions, by creating for example centres of excellence relative to hospital treatment.
3.2.8. The Commission will establish a biannual report on the impact of European policies on health care systems.
3.2.9. The Commission, in the framework of the WTO, must defend at the GATS (General Agreement on Trade in Services) the concept of ‘health care services' as part of services of general interest.
{{4) Measures must also be taken at national level to establish the necessary conditions to allow access for all to quality health care services.[[This resolution also draws on the principles of the Ljubljana Charter for health care reform, WHO Europe 1996. This Charter stipulates that the reforms must be aimed at better health and quality of life for all.]]
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} }}For the trade unions, this means:{{ {
} }}as regards patients, through the introduction of genuine patient rights, including respect of their dignity and their privacy, the guarantee that they will not be subject to observation or medical experiments without their prior authorisation, the right to information concerning their state of health and the treatment as well as the right to decide to accept or reject the recommended treatment and recognition of the role of associations and trade unions as representatives of sick people and users.
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} }}and for the personnel concerned, the means to provide a quality service, which requires notably taking into consideration, in personnel recruitment procedures, patients' needs and not only economic constraints, and ensuring that the personnel recruited benefit from the working conditions, wages, training and qualifications necessary to allow them to provide quality care services; cost control must not be to their detriment.[[This resolution endorses the text of the Ljubljana Charter on Reforming Health Care, 1996, which addresses health care reforms in the specific context of Europe and is centred on the principle that health care should first and foremost lead to better health and quality of life for people.]]