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