Integrating Health Integrating Health across Policiesacross Policies
Health and the Single Health and the Single European MarketEuropean Market
Coheur Alain : Association Internationale de la MutualitéCoheur Alain : Association Internationale de la Mutualité
FREE MOVEMENT OF PATIENTSFREE MOVEMENT OF PATIENTS - Dynamics and evolution of the - Dynamics and evolution of the European context European context - Dynamics of the Euregios- Dynamics of the Euregios- Cross border experiments- Cross border experiments- Divergences, convergences and - Divergences, convergences and perspectivesperspectives
GASTEIN : 27 septembre 2001GASTEIN : 27 septembre 2001
Dynamics of the European context
• Bilateral agreements- Regulations 1408/71- Treaties : Rome - Maastricht - Amsterdam- Charters : Social Charter - Charter of fundamental right- Recommendations- Communications- Councils : Luxembourg - Lisbon - Nice- Judgments
European dynamics
1868Year
1961 1992 1997 20001958
Arrest Kohl
Decker ……...
Nederlands - Belgium France - Belgium
Germany - Belgium
Care providers
Treaty of Maastricht
First bilateral
conventions
Communications from the
Commission
Treaty of Amsterdam
Charter of fundamental rights
art. 34 et 35
Charter of fundamental rights
art. 34 et 35
Treaty of Romeart 42
Reg. 1408/71
Recommendat° Conv. goals
social protect°
European social
Charter art. 11
The dynamic of the Euregios
1. 15 % of the Community’s territory
2. 10 % fo the population
3. 1992 - Interreg I => II - III
4. support for the development and complementary in CB
5. method of partnership and bottom up approach
6. grassroots visibility for the citizens
7. budget are not allocated to the individual member state but by border
10. Each Euregio has a great deal of leeway as regards applying the guidelines
11. Euregio Meuse Rhin => eight priorities
12. “improving cooperation and cross-boder accessibility in health care
Contractual practices•Number of journeys between Maastricht (Transfusion Centre) and Hermalle hospital
May June July Aug. Sept. Oct. Nov. Dec. Jan. Feb. Mar
5 3 4 3 4 2 4 4 5 8 4
•Total number of journeys: 46
•Number of blood bags delivered to Hermalle hospital.
May June July Aug. Sept. Oct. Nov. Dec. Jan. Feb. Mar
12 9 11 10 9 4 15 10 15 24 11•Total number of blood bags delivered: 130
Cross-border experimentsCross-border experiments
Cross-border experimentsCross-border experiments
• Full mobility
CARE French patients Belgian patients receiving care in Belgium receiving care in France
OUTPATIENT CARE 173 patients / 273 examinations
Scanner = 28%
Other medical imag. = 14%
Neurology = 18%
Nuclear medicine = 12%
ONE DAY CLINIC 12 patients / 59 fixed cost
Intravenous perfusion = 24
Chemotherapy = 29
Surgery = 5
Scanner = 1
INPATIENT CARE 8 patients 18 patients
Functional rehabilitation = 13
Haemodialysis = 2
Other = 3
TOTAL 193 patients 18 patients
Cross-border experimentsCross-border experiments
• Full mobility
- on the scope of the mobility
- on the main reason for recourse to cross-border care
- on geographical accessibility
- on the consumer profile
- on the type of medical specialities
Cross-border experimentsCross-border experiments
• Types of medical specialitiesBelgium Germany Total
1 Ophthalmology 50 119 169 (17%)
2 Gynaecology 1 120 121 (12%)
3 Orthopaedics 8 101 109 (11%)
4 Internal medicine 2 100 102 (10%)
5 Dermatology 40 53 93 (9%)
6 Scan 5 75 80 (8%)
Etc.
DivergencesDivergences
• historical and legal development of European social models
• the organisation and financing of social security and health insurance
• the role played by the publics authorities, the social partners ans private organisations in the decision-making process and the implementation of health systems a restrictive policy on access to cross-border a liberal policy on access
the room of maneouvre within the Euregios the room of maneouvre within the Euregios is very smallis very small
ConvergencesConvergences
• the consequences of the Legal rulings by the European Communities
• the development on a national level
• the uniqueness of the Eurogios
• the growing diversity in cross-border circulation
• the proximity of the care
a relaxation in the cross-border care arrangements, with accessibility for all insured persons, and with the greatest common denominator as regards what is laid down in the arrangements ( for two or three countries, depending on the Euregio involved) for social security coverage in respect of health care;
the emergence of a cross-border traffic for local care supplementing, where necessary, what can be provided to insured persons in their own country;
an extension to patients and insured persons from other Euregios, in the context of bilateral and multilateral (experimental) arrangements, cross-border care which at the outset will be available only to the residents of one Euregio and mainly for high-technology care.
PerspectivesPerspectives
• The Euregio projects should receive greater support The Euregio projects should receive greater support from the European authorities. A complete listing of from the European authorities. A complete listing of all cross-border initiatives should be prepared, a all cross-border initiatives should be prepared, a survey of Euregio infrastructure should be carried survey of Euregio infrastructure should be carried out, and a profile of the populations involved should out, and a profile of the populations involved should be drawn up. This information would make it be drawn up. This information would make it possible to draw up a specific action programme for possible to draw up a specific action programme for the development of cross-border activities in the the development of cross-border activities in the field of health. The effect of this proposal could be to field of health. The effect of this proposal could be to remove the obstacles to the reform of Regulation remove the obstacles to the reform of Regulation 1408/71 by offering new prospects in the field of 1408/71 by offering new prospects in the field of healthhealth. .
CONCLUSIONSCONCLUSIONS