Brussels, 16/12/2008 (Agence Europe) - Are there states' rights that can be opposed to patients' rights? Such was the question that might have been asked by the public attending the health ministers' discussion on the draft cross-border healthcare directive on Tuesday 16 December.
Discussions, chaired by Roselyne Bachelot-Narquin, showed that there was virtual unanimity among member states on those parts of the compromise proposed by the French Presidency to: - require prior authorisation for hospital treatment and special care (the Commission proposal only accepted the reintroduction of prior authorisation when there were too many patients seeking treatment abroad); - leave it to states to define for themselves the nature of this hospital treatment (the Commission wanted the decision to be taken through the comitology procedure); - remove from the directive reference to healthcare quality standards, each member state determining its own standards.
Here is a flavour of the morning's speeches. Stating that the current proposal was “unacceptable”, Luxembourg minister Mars Di Bartolomeo called for “a right to prior authorisation”. However, Belgian minister Laurette Onkelinx said she thought that there had to be preparation for a great influx of patients and the problems that could be caused by care packages contracted by insurance companies with hospitals. Like German minister Ulla Schmidt, she felt that a solution had also to be found to the specific issue of long-term care. Portuguese minister Ana Jorge wanted the legal services to determine whether the proposal was compatible with Article 152.5 of the Treaty (member states' responsibility for health systems). While saying she backed a legal framework that took account of the Court of Justice case law, the Irish minister felt that the Commission proposal did not take sufficient account of the necessary balance between patients' rights and the responsibilities of states. The Hungarian representative felt that everything had to be done to avoid aggravating the imbalance between rich and poor in access to healthcare. Spanish minister Bernat Soria said that the directive should, first, define rights in terms of supply, equality of access and quality of care. He backed a consolidation of the way opened by the social security regulation to avoid any legal uncertainty. The Swedish representative acknowledged that “there is nothing to show that present mobility might undermine member states' planning capacity”. He felt that the measures to handle the influx of patients should always be proportionate and justified. The Slovenian representative said he was in favour of adopting legislation with transparent rules for patients and states. Such legislation must respect the principles of availability to all, fairness and solidarity, and take account of national differences. “We are expecting a lot of European reference networks,” he added. The Greek, Finnish and Dutch ministers gave their backing to the Presidency's compromise. The Italian representative highlighted the need to respect regional responsibility and argued for the introduction of approval for private organisations.
Responding to ministers, Commissioner Androulla Vassiliou said that the Commission was prepared to remove long-term treatment, but she warned of the dangers inherent in diluting the text. She noted that under the initial proposal, member states would be able to refuse patients coming from other member states if there was a lack of capacity, but that such steps must be proportionate and justifiable. “The Court has set rights which patients must be able to use effectively,” she said, highlighting that patients would not lose these rights, which derive from the Treaty, just because a more restrictive directive is adopted. She pointed out that mobility was not a huge issue, not exceeding 1% of health spending and that the “Court has clearly said that any prior authorisation has to be justified, reasoned and proportionate”. The commissioner also argued for the retention of arrangements referring to quality and security of care, because it was that which differentiated between healthcare services and other commercial services which were covered by the services directive. (O.J./transl.rt)