Brussels, 01/12/2009 (Agence Europe) - Neither the efforts of the Swedish Presidency, not the conciliatory attitude of member states prepared to approve the compromise text put forward by the Presidency were enough on Tuesday 1 December for political agreement to be reached on the draft directive on patients' rights in cross-border healthcare (see also EUROPE 10030). Discussion will, then, have to continue, as a considerable number of member states wanted. The debate concentrated to a large extent on the difficulties experienced by a group of member states with regard to the inclusion of unapproved care providers. To resolve this problem, the Presidency proposed in vain to include in a preamble, then in the body of the text, the possibility for member states not to reimburse care delivered, in the member state, by non-contractual providers or, indeed not to reimburse such care delivered in another member state.
16 member states wanted political agreement on the basis of the Presidency proposal. Thus the United Kingdom representative backed the text, pointing out the considerable progress made since the first Council discussion. Germany backed the compromise, which it saw as balanced. While regretting that the compromise text still contained areas of legal uncertainty for patients and a margin for interpretation by European courts, the Czech Republic representative acknowledged that it was the best outcome that could be achieved at this stage and he hoped that negotiation with the Parliament would iron out some points. It was, the Danish representative said, “a difficult issue for everyone”, and he felt that the Presidency's text was generally satisfactory, even though his country wanted medical supplies excluded. Satisfied with the guarantee brought by the “basic principle of prior authorisation”, France could accept the text proposed by the Presidency for unapproved providers, although it was happy with non-discriminatory inclusion. “Political agreement has to be reached today to best defend the interests of the Council in negotiations with the Parliament,” its representative said. The Dutch representative said that the system put in place in the Netherlands in 2006 to take account of Court rulings, had proved its effectiveness without distorting the health system. Latvia, Italy (despite considerable reservations), Austria, Bulgaria, Finland, Luxembourg, Belgium, Malta, Estonia and Sweden also backed approval of a political agreement.
11 member states said they had problems. For Spain, which experienced huge difficulties with the text, the compromises proposed on the definition of the state of affiliation and unauthorised providers were still unsatisfactory. Slovakia insisted on the exclusion of unapproved providers. This viewpoint was shared by Hungary, which called for the draft preamble to be at least amended into a draft directive. The representative from Portugal stated that the inclusion of unapproved providers was not acceptable and “infringes national competence”. She refused to accept that, health be managed through the internal market and the patients be treated as no more than consumers. “We cannot agree to our health system being driven by the market,” she added, before calling for discussion to continue to find real consensus within the Council. Romania also called for the exclusion of unauthorised providers to be stipulated in the body of the directive. Slovenia said it shared Hungry and Portugal's stances on the “negative implications of the market”. Greece wanted more discussion on unauthorised providers and on recognition of prescriptions. While expressing her reservations on providers and the state of affiliation, the Irish representative said she could subscribe to the compromise if the provision on unauthorised providers was included in an Article. Lithuania, Poland and Cyprus wanted further discussion to improve the text.
“We need an agreement today ..; otherwise we will have to explain why not to European citizens,” said Health Commissioner Androulla Vassiliou. She said the Commission was prepared to agree to the preamble on unauthorised providers being made into an Article in the directive. She hoped that that might bring political agreement. However, after a pause, the Swedish Presidency had to accept at the start of the afternoon that there was still no qualified majority on this text. (O.J./transl.rt)