European Union: Commission Adopts Package on Healthcare

The European Commission has adopted a package of two Communications and an Action Plan on healthcare as part of its response to the broad challenges that are facing health services across the European Union ("EU"). They are:

• A Communication on modernising social protection for the development of high-quality, accessible and sustainable healthcare and longterm care: support for the national strategies using the "open method of co-ordination";

• A Communication being the follow-up to the high level reflection process on patient mobility and healthcare developments in the European Union;

• e-Health making healthcare better for European citizens: an Action Plan for a European e-Health Area.

These initiatives together set out the Commission's strategy for developing a shared vision for the European healthcare and social protection systems. This article will first set out some of the common challenges the Commission has identified that all EU healthcare systems are facing and then summarise main elements of the two Communications. The action plan on e-Health is discussed in a separate article, "European Commission Adopts e-health Action Plan".

The Commission has identified a number of challenges that are currently facing the various healthcare systems around the EU. They include:

• a rising demand for health and social services due to ageing populations, higher incomes and education levels;

• increasing expectations of citizens who want the best care available and at the same time to experience a reduction of inequalities in access to good healthcare;

• increasing mobility of patients and health professionals within a better functioning internal market;

• the need to reduce the "disease-burden" and to respond to emerging disease risks (eg SARS);

• the difficulties experienced by public authorities in making investment in technology;

• the need to limit occupational accidents and diseases, to reinforce well-being at work and to address new forms of work-related diseases;

• management of huge amounts of health information that needs to be available securely, accessibly, and in a timely manner at the point of need and processed efficiently for administrative purposes; and

• the need to provide the best possible healthcare under limited budgetary conditions.

Social protection is a means by which costs, among other things, that are beyond the means of the individual, are shared across society. This ensures that all individuals should have access to social protection including healthcare, even if they have low incomes. Member States address social protection in a variety of ways, including direct provision of services and insurance-based schemes. Under the EC Treaty the primary responsibility for social protection, including healthcare, lies with the Member States. However recently there has been a consensus that, given the importance, including healthcare, of this issue, there should be better cooperation at EU level.

The enlargement of the EU is likely to add to the diversity in social protection in the EU. Generally the main health indicators are worse in the new Member States and they spend less on healthcare systems. The March 2000 Lisbon European Council set out a framework under which the new Member States could "catch-up" in terms of the level and quality of care. This process is on-going. At the same time, there is increasing integration in the EU which has led to interaction between the healthcare systems. In particular, individuals are increasingly choosing to live in a Member State, other than their own, and to require access to the host Member State's healthcare system. The Commission foresees a common framework to support Member States in the reform and development of healthcare and long-term care using the "open method of co-ordination"¹. The Communication sets out objectives for developing and modernising both the provision and funding of healthcare. The framework would allow Member States to define their own national strategy whilst allowing them to derive benefits from the experiences and good practices of other Member States.

The Commission proposes that the following objectives be endorsed to support the development of the social protection systems throughout the newly enlarged EU:

• ensuring access to high-quality health and longterm care based on the principles of universal access, fairness and solidarity;

• providing a safety net against poverty or social exclusion associated with ill-health, accident, disability or old age, for both the beneficiaries of care and their families;

• promoting high-quality care in order to improve people's state of health and quality of life;

• ensuring the long-term financial sustainability of high-quality care accessible to all.

In summary, the Communication identifies challenges common to all Member States' systems of social protection and objectives that could underpin meeting these challenges. The Commission states that it would be desirable for Member States to agree these objectives during 2004. Member States would then present "preliminary reports" on the challenges facing their national system in Spring 2005. Following analysis of this information, the intention is that the Commission will then be able to establish joint objectives of a streamlined social security process. This would be followed by a series of "development and reform strategies" in health and long-term care in 2006-2009. The conclusions of the assessment of these strategies would then be presented in a joint report on social protection and social inclusion in 2007.

This Communication is the Commission's response to the recommendations of a "high level process of reflection". Its overall objective is a high level of human health protection and it presents a set of proposals covering many different areas related to patient mobility and healthcare.

It starts from the premise that patients want to receive high quality healthcare as close to their home and as quickly as possible. However sometimes this can be best achieved through healthcare provided in another Member State. In the EU citizens can seek healthcare in Member States other than their own and the European Court of Justice has clarified the conditions for reimbursement.² Patient mobility is one of the common challenges faced by health care systems. The Communication states that co-operation is needed between the national health care systems in order to better meet this challenge. Such cooperation should bring benefits for both the patients and the healthcare systems.

The Communication is broadly divided under four headings:

• European co-operation to enable better use of resources;

• information requirements for patients, professionals and policy-makers;

• the European contribution to health objectives; and

• responding to enlargement through investment in health and health infrastructure.

It sets out a number of ways in which collaboration at the EU level can deliver benefits to the effectiveness and the efficiency of health services. These include: collaboration to make better use of resources; developing a better understanding of the rights and duties of patients; sharing spare capacity between systems and cross-border care; mobility of health-care professionals; identifying and networking European centres of reference and coordinating assessment of new health technologies.

The Communications discussed above, together with the Action Plan on e-Health (see separate article, "European Commission Adopts e-health Action Plan), anticipate that achieving the outlined objectives will be a long and complex project. It is anticipated that further proposals will probably be needed in the future. However the Commission sees this investment as essential to achieving better health and quality of life throughout the EU.

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