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Markos Kyprianou

European Commissioner for Health

"Addressing the Challenges of Cross-Border Health Care"

10th Health Forum on "Health Services"
Gastein, Austria, 05 October 2007

I am very pleased to be here today – and in particular to be present at the 10th anniversary of the Gastein Forum.

Over the years this Forum has become established as a key event in the health calendar – an ideal opportunity for broad reflection and the exchange of forward thinking views.

Of course, this year we are also celebrating 50 years of progressive European development and co-operation – 50 years since the signing of the Treaty of Rome.

And while the anniversary gives grounds for us to recognise and celebrate the progress of the last 50 years, it also presents an ideal opportunity for us to re-focus on how best to meet the challenges of the future.

Health is a case in point. Health now enjoys a much more prominent position on the European agenda than it did 50 years ago.

There is now real momentum in European health policy.

We must exploit this momentum to ensure that health interests are sufficiently taken into account and respected in European policy making; and to ensure that the EU contributes to a high level of health protection in all its Member States.

The Gastein Forum has consistently played an important role in this process, as a unique platform for exchange of new ideas and building co-operation between various players in the health field.

I congratulate the organisers of this event for keeping up this tradition.

I am also delighted to hear of this year's initiative (with the Commission's support) to invite a number of young officials and young researchers to Gastein for the first time.

I hope this initiative will continue at future Gastein events, bringing a new and welcome dimension to the Forum.

A new EU Initiative on cross-border healthcare helping to address new challenges

Europe has changed dramatically over the last 50 years – and faces many new challenges. For example:

  • The population is ageing.
  • Citizens demand more information and better care, while healthcare budgets are already stretched.
  • There are wide disparities in the health status of citizens and quality of healthcare between different Member States, regions and social groups.

In order to be able to better address these challenges, there is clearly a growing demand for the EU to act on health.

One of the important areas where the Commission is preparing Community action concerns health services and cross-border healthcare.

These issues have been discussed widely at European level in recent years.

Areas of legal uncertainty and areas of potential added value of European action have been identified. The time is now ripe to take action.

We need to address current uncertainties about the application of Community law to health services, and to provide support for efforts to improve effectiveness, efficiency, quality and safety of national health systems.

General support for Community action on health services

The Commission obviously can not achieve these goals on its own.

We need to work together with all health stakeholders if we are to achieve the outcomes to which we aspire.

Within this spirit we first held a broad consultation on these issues, which was formally closed at the end of January this year.

We received more than 270 contributions – most of them of high quality, containing many interesting ideas. We have summarised the responses in a report that can be downloaded from our website. We have also received the European Parliament's views on these issues.

The contributions provide many different views on the details, but the overall picture is clear – there is wide recognition of the potential added value for patients, professionals, hospitals and health systems overall from some form of Community action on health services.

Health ministers have welcomed the Commission's initiative and endorsed the need for action.

Proposal on cross-border healthcare

The Commission is now finalising formal proposals to be presented before the end of this year.

I do not want to prejudge the final outcomes of that work – however, these proposals should be based on the following elements and principles:

Patients normally prefer to be treated near to their homes whenever possible. But sometimes the healthcare they need is provided in another Member State.

We must ensure clear and transparent information on the patients' rights and obligations.

Important for patients and hospitals alike is clarity about the authority that is overseeing quality and safety in cross-border cases.

There is a broad consensus that the authorities of the country where treatment is provided should be responsible for ensuring that services are safe and of sufficient quality.

Closely related and equally important is the need for clarity on procedures in the case of harm to a patient.

Linked to this is the issue of professional liability for cross-border healthcare. Mandatory liability insurance or similar guarantees could be an attractive strategy to protect patients and providers alike.

For example, in a recent case from one of the newer Member States, a patient claimed €100,000 of compensation from a hospital. The value of the hospital itself being only twice as much that claim, the national government had to finance the compensation through public funding. Liability insurance would have avoided such a situation.

We need also to clarify rules about access to healthcare in other Member States and the basis on which it will be provided, including issues of reimbursement of costs of cross-border healthcare, administrative procedures and guarantees of objective and timely handling of requests.

It is the primary responsibility of the Member States and of the Regions to make sufficient efforts in order to improve overall efficiency of healthcare in the EU.

However, in this field there are several areas where the scale or nature of action is such that it would be most effective if undertaken at EU level.

We should therefore aim to reduce inequalities and disparities between regions by enabling interaction and cooperation between different health systems.

Health technology assessment is a good example, where it is more efficient for everyone to collaborate on assessing new health technologies rather than duplicating assessments across the Member States.

A clear framework at EU level would also provide clarity for healthcare purchasers and health insurers to take full advantage of expertise in other Member States, such as through European networks of centres of reference.

We can also establish a mechanism for exchange of best practice regarding the most efficient use of support from the structural funds in healthcare and for co-operation on healthcare planning and provision in border regions.

Effective transfer of best practice and development of comparative statistics between the regions is another field that can generate great synergies.

A very good example is the Europe Against Cancer programme, which developed for the first time comparative statistics about outcomes for different cancers across Europe.

The outcomes revealed some dramatic variations between Member States – and prompted action in a number of countries on the reforms of cancer services over recent years.

As I have said, the Commission plans to bring forward concrete proposals on cross-border health services before the end of this year.

This is likely to be a package of legislative and non-legislative measures, a directive and a communication.

Some problems may require firm legal provisions. But in other areas, practical cooperation, better transparency and exchanges of information and expertise may be more effective.

In this process we will respect social objectives, as well as common values such as universality, access to good quality care, equity and solidarity – as set out by health ministers in June 2006.

These provide a good reference point for any Community action, and the Commission proposals should be based on these values.

Conclusions and future

This is an exciting time for EU health policy. We have big ambitions.

However, we have to be realistic. We cannot hope to solve every problem at the same time.

We will proceed step by step – and some issues may need to be left for future proposals.

The Commission plans, for example, two further specific initiatives in 2008 – one on patient safety and another on a health workforce in Europe.

In all cases, our benchmark must remain what works in practice for patients, physicians, hospitals and for health systems as a whole.

I look forward to your continued input in helping to ensure that we meet that test.

Finally, I would like to thank, once again, the organisers of this excellent event.

A special workshop on "EU and health services" will take place tomorrow morning. I am sure that the session tomorrow will be a rich source of interesting and fruitful discussions – and I look forward to hearing the results of your deliberations.

Thank you.

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