Local view for "http://purl.org/linkedpolitics/eu/plenary/2008-09-25-Speech-4-059"
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"en.20080925.4.4-059"2
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".
Mr President, Commissioner, ladies and gentlemen, let me start with a few personal comments and say how happy I was to meet up again with my colleagues from the Committee on Employment and Social Affairs, Mr Andersson, its chairman, Anne Van Lancker, Ria Oomen-Ruijten, Jiří Maštálka and others. May I offer them my warmest greetings.
Similarly, this is not just a directive on health services, to be regretted or welcomed. So it serves no useful purpose to decry it as some kind of ‘Bolkestein directive’. That really is not what this directive is about.
Once its basic principles have been established – and I have noted them – this directive must therefore enable us to preserve a certain means of regulation, as it already exists between the Commission and the Council but also between many MEPs on all benches, in regard to respect for these options open to patients. As regards prior authorisation for cross-border healthcare, Member States must remain responsible for deciding on the range of care they offer.
It is also important that when a state imposes certain conditions of access to care for public health reasons – such as the doctor’s referral system or what is known as gate-keeping in English – its systems are respected and applied when patients turn to a health system in a country other than their own.
Obviously, this discussion on the directive cannot be dissociated from the Commission’s forthcoming communication or from the Council’s proposal for a recommendation on Community action in the field of rare diseases. I believe it is entirely possible to hold those discussions at the same time. Another issue that many MEPs raised was the interoperability of health information systems. This directive may contribute to that in legislative terms.
Commissioner, ladies and gentlemen, of course we are only at the start of this dialogue, of the discussion on this subject, which will have to cover such vast areas as data protection, transparent enacting terms and perimeters. Here again, however, with the directive creating legal certainty, we should be able to advance along the road of interoperability, which does not mean going it alone but, quite simply, harmonisation and greater compatibility.
Thank you all for your deep and meaningful contributions, which have shed great light on our debate.
John Bowis, speaking on behalf of the PPE, put the issue in its proper context by asking: ‘What does Europe do for me?’ He reintroduced the question of a neighbourhood Europe, followed by numerous others such as Dagmar Roth-Behrendt on behalf of the Socialist Party and Jules Maaten for the ALDE Group.
Many of those who spoke after John Bowis also emphasised that patients take precedence over states and systems. That is very true. Yet we must not end up by opposing patients, states and health insurance systems because any destabilisation of health insurance systems would have dreadful repercussions on the organisation of healthcare and, specifically, on the patients we want to protect.
That is why I would reply to Dagmar Roth-Behrendt that the question is not of patients’ right of movement within the European Union, which is a self-evident, fundamental right. The question the directive raises is of reimbursement and reimbursement terms, of the right or not to reimbursement. Article 152 of the Treaty makes it clear that Member States are free to organise and finance the healthcare they provide as they wish.
At the heart of the issue of prior authorisation lies the question of balance, of the soundness of the accounts of the national health support and insurance systems, especially those of the poorest states. This text reminds us of that responsibility and under no circumstances can states use this directive as a means of evading those responsibilities.
Basically, Jean Lambert was saying that cross-border care is not a goal in itself and Derek Roland Clark pointed out that perhaps we should make sure the provisions of the new directive did not ultimately benefit only a few of the wealthiest, most educated and best informed patients while the poorest patients would, of course, be treated unfairly.
The key question here, however, the question under debate, which the Commission and the Council should look at in depth, is prior authorisation for hospital care because that is indeed where there is the greatest risk of deregulation of national systems.
Jean Lambert asked whether the proposal for a directive was compatible with the regulation on social security coordination. The Court has found that those two reimbursement systems were compatible. We must ensure, therefore, that the two systems are properly structured. The proposal for a directive before us gives priority to implementing the regulation, which seems reasonable. Yet the principle of the patient’s freedom of choice must continue to apply if, for any reason other than financial, a patient prefers to go down the road opened by ECJ case law.
Like Bernadette Vergnaud, some MEPs regretted the fact that this text does not cover all the difficulties encountered by patients within the EU, and more specifically in their country of origin. When you look at the difficulties to be resolved by this text alone, you can see that it was unlikely that proposing a wider-ranging text would have been the best way of making progress in terms of resolving certain very practical problems, such as reimbursing healthcare for patients moving to another European country for the purpose of study, work or simply holidays."@en1
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