4. Calls on the affected Member States to update their legislation so as to prevent unsustainable spatial
planning, infrastructure installation and house-building in hydro-geologically vulnerable areas, and calls on
the competent authorities to ensure that up-to-date maps of their country’s at-risk areas are drawn up;
5. Calls on the Council and the Commission to take initiatives designed to strengthen cooperation and
action in the field of spatial planning, in accordance with the guidelines of the European Spatial Develop-
ment Perspective (ESDP), particularly in the field of reforestation, agri-environmental measures, sustainable
water-basin management;
6. Considers that environmental and conservation policy must constitute a priority in government
action and that steps must continue to be taken in order to devise and implement projects for improvingland use and preventing risk;
7. Calls on the Commission to promote suitable initiatives under the LIFE programme, with a view to
re-establishing a high-quality environment in sensitive areas, and to consider the merits of establishing
appropriate support measures for affected regions;
8. Welcomes the drafting of Community instruments coordinating the various civil protection systems
at European level, in order to make them more readily available and useable in the event of natural dis-
asters;
9. Considers that Europe is currently experiencing the impact of climate change and that action is
urgently needed at local, national and international level in order to counter its effects;
10. Reiterates its view that during the current Conference on Climate Change in The Hague, the Eur-
opean Union and its Member States should again play a leading role in international efforts to reduce
greenhouse gas emissions and halt climate change, and should implement ambitious measures as part of
an overall climate-change strategy;
11. Instructs its President to forward this resolution to the Council, the Commission, the governments
of the United Kingdom, Ireland, Italy, Spain and France and the parliaments and leaders of the regional
communities involved.
12. Supplementary health insurance
A5-0266/2000
European Parliament resolution on supplementary health insurance (2000/2009(INI))
The European Parliament,
9dash having regard to the Treaty establishing the European Community and, in particular, Articles 2, 152
and 308 thereof,
9dash having regard to the decisions of the special European Council held in Lisbon on 23/24 March 2000,9dash having regard to its resolution of 15March 2000 on the forthcoming special European Council to be
held on 23 and 24 March 2000(
1),
9dash having regard to the Commission’s report on social protection in Europe in 1999 (COM(2000) 163),9dash having regard to the communication from the Commission ‘A concerted strategy for modernising
social protection’ (COM(1999) 347 9dash C5-0253/1999) and the European Parliament’s resolution of16 February 2000(
2) on that communication,
9dash having to the Commission’s report on social protection in Europe in 1997 (COM(1998) 243 9dash
C4-0375/1998) and the European Parliament’s resolution of 12 March 1999(3) on that report,
(1) ‘Text Adopted’, Item 12.
(2) ‘Text Adopted’, Item 7.
(3) OJ C 175, 21.6.1999, p. 435.8.8.2001 EN C 223/339 Official Journal of the European Communities
Thursday 16 November 2000
9dash having regard to the communication from the Commission ‘Modernising and improving social protec-
tion in the European Union’ (COM(1997) 102 9dash C4-0143/1997) and the European Parliament’s reso-lution of 11 June 1997(
1) on that communication,
9dash having regard to the communication from the Commission ‘Services of general interest in Europe’
(COM(1996) 443 9dash C4-0507/1996),
9dash having regard to the communication from the Commission ‘The future of social protection: a frame-
work for a European debate’ (COM(1995) 466 9dash C4-0524/1995),
9dash having regard to the Council’s Recommendation of 27 July 1992 on the convergence of social protec-
tion objectives and policies(2),
9dash having regard to Articles 9 and 12 of the International Covenant on Economic, Social and Cultural
Rights(3),
9dash having regard to the opinion of the Economic and Social Committee on supplementary health insur-
ance(4),
9dash having regard to Rule 163 of its Rules of Procedure,9dash having regard to the report of the Committee on Employment and Social Affairs and the opinion of
the Committee on Economic and Monetary Affairs (A5-0266/2000),
A. whereas the European Union is served by a diverse collection of health and social protection systems;
whereas the years of low economic growth, rising unemployment and social exclusion, the reduction
in European citizens’ purchasing power and ability to contribute to public finances, the ageing of the
population, the emergence of new diseases, together with advances in medical research and treatment,
have resulted in a marked increase in healthcare costs; whereas all the Member States are now facingthe same problems with regard to the need to control and cover the cost of health care,
B. whereas governments have generally opted to tighten their control over health spending, particularly
by introducing a system of charges for patients, and whereas this trend affects individuals’ freedom of
movement and raises various common problems which ought to be discussed and acted upon at
European level, without prejudice to the Member States’ respective responsibilities in that area andthe principle of subsidiarity,
C. whereas the difficulties ensuing from the situation described in recital A may cause a growing number
of European citizens not to seek the necessary treatment and to restrict themselves to emergencies,
and that this state of affairs, which is becoming widespread, must not be allowed to continue in the
European Union, which is increasingly committed to combating discrimination, promoting equal
opportunity and fighting social exclusion,
D. whereas it is both necessary and sensible to oppose a trend which, supposedly on the grounds of
economy, good management and making people responsible for their own welfare, has the effect of
reducing high-quality health cover and transferring certain risks covered by the statutory schemes to
the supplementary schemes,
E. whereas national insurance has made it possible to ensure a suitable standard of living and alleviate
poverty in most Member States,
F. whereas all the Member States have adopted the WHO’s ‘Health For All’ (HFA) 2000 objectives and
drawn up programmes intended to ensure access to those who require it most urgently,
G. whereas Europe is in the vanguard in terms of access to medical care, but the way in which systems
are organised and financed differs considerably from one State to another,
H. whereas, although cooperation between the Member States in the health sector is already well devel-
oped and should serve to carry into effect the basic principles set out in Article 2 of the Treaty, never-
theless prime responsibility still lies with the Member States pursuant to the principle of subsidiarity,
(1) OJ C 358, 24.11.1997, p. 15.
(2) OJ L 245, 26.8.1992, p. 49.
(3) Adopted and opened for signature, ratification and accession by Resolution 2200 A (XXI) of the General Assembly
of the United Nations of 16 December 1966.
(4) OJ C 204, 18.7.2000, p. 51.C 223/340 EN 8.8.2001 Official Journal of the European Communities
Thursday 16 November 2000
I. whereas health protection is no longer provided solely by state or statutory social protection systems,
and whereas private-sector schemes set up on a profit-making or non-profit-making basis under the
general heading of supplementary health insurance have developed and are playing an increasingly
decisive role in providing access to essential, high-quality care within reasonable time limits,
J. whereas the differences between the health insurance systems in the Member States, particularly where
combinations of public basic insurance and private supplementary insurance exist, may create serious
obstacles to the free movement of persons and freedom to reside in another Member State, and
whereas this may cause problems in particular to frontier workers and their dependants after the
‘end’ of their working lives,
K. whereas access to high-quality medical care within reasonable time limits should be guaranteed
regardless of individual risk or means and that discriminating factors of a financial or congenital nat-
ure must not have the effect of excluding European citizens from adequate health insurance cover,
i.e. insurance cover based on the principle of solidarity,
L. whereas, without calling into question the working methods of the supplementary health insurance
organisations which operate in accordance with techniques used in the profession and in a competi-
tive environment, they must actively participate, by applying ethical principles, in improving access to
high-quality medical care, within reasonable time limits, for the widest possible public,
M. whereas, in several Member States, insurers and insured have laid down codes of good conduct and it
is important to support them and to encourage them to take into account measures aimed at increas-
ing social cohesion in the Union and whereas in the other Member States, all parties should collabo-
rate in a framework established at national level to achieve the same objective,
N. whereas there is a lack of detailed and comparable statistics on the health services’ ability to meet the
need to ensure access to adequate medical care for everyone, and whereas it is important to assess the
practices followed in the Member States, to analyse the behaviour of citizens in terms of seeking or
failing to seek treatment, and to obtain comparable data which can inform policy-making at national
and European level,
O. whereas a global approach to health protection is the best way to meet the needs of European citi-
zens, and particularly of the most vulnerable to social exclusion, and whereas it is important to recog-
nise at Community level, without prejudice to the principle of subsidiarity, the right of all citizens to
have access to adequate and high-quality medical care and to establish rules guaranteeing minimum
provisions for meeting the cost of medical treatment in accordance with ethical principles which
should apply, via recommendations and directives, to the Member States and to the supplementaryhealth insurance organisations,
1. Draws attention to the provision in the draft Charter of Fundamental Rights which stipulates that
everyone has the right of access to preventive health care and the right to benefit from medical treatment
under the conditions established by national laws and practices and that a high level of human health
protection is to be ensured in the definition and implementation of all Union policies and activities;
2. Draws attention to the fact that social insurance systems are based on the principle of social solidar-
ity between and within generations, which it is essential to uphold;
3. Draws attention to the considerable problem of financing statutory health care systems as a result of
demographic trends, the current high level of unemployment, medical advances and increased demand formedical treatment;
4. Draws attention to the significant problems regarding the sustainability of public health care systems,
which come under pressure because of the ageing European population, unemployment and increasing
demand, inefficiencies in the management and provision of health services;
5. Emphasises that State social security has made possible an adequate standard of living and a reduc-
tion in poverty in most Member States, is an expression of social solidarity between the generations the
various peoples of the European Union and this model must remain the cornerstone of the social security
system of the European Union;8.8.2001 EN C 223/341 Official Journal of the European Communities
Thursday 16 November 2000
6. Points out that during the 1980s and early 1990s the share of total health expenditure allowed for
by public resources steadily decreased in almost all Member States, and above all a very varied range of
products and services was developed;
7. Calls on the Commission to analyse how the healthcare systems can meet the objective of providing
access for all to high-quality treatment for which there is a demonstrable need within reasonable time
limits, with special reference to the problem of the interconnections between health insurance schemes
for people who move to another Member State and/or take employment in another Member State and/or
come to the ‘end’ of their working lives as frontier workers; anticipates that the collection of statistics and
comparable data would make it possible to develop effective cooperation between the Member States,which would lead to best practice being applied; considers that such a Community monitoring systemshould be established by extending the remit of an existing Community agency that would collaboratewith networks operating in the Member States or internationally, and with the help of Eurostat;
8. Considers that supplementary health insurance in the internal European market will play an increas-
ingly important role in covering various health risks and therefore has a key function in complementingthe statutory healthcare system;
9. Takes the view that the use of supplementary insurance to cover various health risks could serve to
complement statutory care systems;
10. Insists on the need to develop a common view of universal services in the light of the Amsterdam
Treaty and to respect the subsidiarity principle which allows citizens and inhabitants of the EuropeanUnion access to essential health services within a reasonable timeframe; considers it indispensable in this
connection that a constructive dialogue be conducted between those responsible in the public health ser-
vices and the supplementary insurance schemes;
11. Calls on the Commission to present, within a period of six months, a green paper on the current
situation with regard to the Member States’ policies; the green paper should indicate ways in which theexisting systems could be effectively supplemented and maintained by means of supplementary careschemes while providing high-quality medical care; calls on the Commission to examine the possibility,on the basis of the green paper, of a framework for supplementary health insurance schemes which takesaccount of the subsidiarity principle, and to propose appropriate legislative initiatives, and preferably aproposal for a recommendation, which may include the following points:
(a) recognition of a common concept of basic service to govern the basic service which will enable every
European citizen to have access, in his or her country of residence, to necessary and high-quality carewithin reasonable time limits; it will be the task of the Member States to determine the scope and
participate in the implementation of this basic service, which should be based on the Community
principle of general interest;
(b) establishing, in agreement with the private insuring bodies, guaranteed respect for the principle of
basing contributions on a unitary premium and the principle of non-discrimination between sections
of the population on health, age or financial grounds;
(c) the need to ensure that all necessary medical treatment and care is guaranteed to the elderly also;
(d) organising a system of pooling costs in order to cover the costs of persons and groups with serious
existing diseases or pathologic conditions; in the case of insurance systems where such cover is usually
not available, various solutions could be envisaged, for example: the creation of guarantee funds by
insurance providers which would cover the cost of additional premiums or provide direct cover for
risks, or else the drawing up of group contracts by representative associations;
(e) encouraging private insurers to participate in public policies aimed at monitoring contagious diseases
and developing preventive measures for the whole population;
12. Calls on the Commission to examine the possibility, on the basis of a green paper, of a framework
for supplementary health insurance schemes which takes account of the subsidiarity principle, and to pro-pose appropriate legislative initiatives, and preferably a proposal for a directive, which may include thefollowing points:
(a) a prohibition on the use of personal medical data, such as genetic typing, to enable insurers to act in a
discriminating way; it is recommended that the European rule introducing that prohibition should not
enter into effect until five years after its adoption;C 223/342 EN 8.8.2001 Official Journal of the European Communities
Thursday 16 November 2000
(b) ensuring that persons joining a scheme are not in principle required to undergo a medical, except
where one is laid down as part of an officially approved code of conduct concluded amongst compa-
nies for the purpose of preventing situations where only good risks are selected; however, the possi-
bility of requiring people to complete a medical questionnaire before a contract is concluded would bemaintained; any serious diseases or disorders would be declared in a document lodged with a trusted
third party; a document could be forwarded to the insurer after a specified period;
(c) the introduction of an obligation to provide lifelong insurance by the insurer, or by successive insurers
if the policy is transferred; the consumer’s right to cancel the contract at specified intervals would bemaintained, in accordance with national legislation on the duration of contracts;
(d) rules concerning the coordination of conditions, contributions and insurance rights applicable to
insured persons who change their country of residence and/or employment within the EU;
(e) the right of insured persons and their dependent family members to make use of facilities in all EU
Member States and the obligation for health insurers to adopt a more flexible approach to the grant-
ing of refunds for such use;
(f) guarantees aimed at ensuring transparency, particularly with regard to the level of any commission
paid to intermediaries and foreseeable changes in charges on the grounds, for example, of age;
(g) the introduction of a mediation procedure in each Member State to facilitate the assessment and reso-
lution of disputes between insurers and insured persons;
13. Calls on the Commission to submit a green paper on the situation of voluntary and supplementary
health insurance in the EU, examining the following questions in particular:
9dash what steps are taken to prevent commercial abuse?
9dash how can the freedom of movement of workers be guaranteed?9dash what considerations are relevant in avoiding dual taxation?
9dash what steps are taken to promote the provision of information to consumers?
9dash what steps are taken to overcome the helplessness of some consumers owing to low income and
difficulties in finding the correct information?
9dash what steps are taken to prevent the exclusion of disadvantaged population groups from insurance
protection, such as the elderly and the disabled?;
14. Considers that it would be very desirable for these measures to support and encourage the codes of
conduct for insurers concluded on a national or transnational basis, particularly when their aim is to go
beyond the present proposals;
15. Calls on the Commission to arrange for the coordinating regulation, Regulation (EEC) No 1408/
71(
1), to apply to all health insurance schemes, including supplementary schemes which are subscribed
to and financed privately but which are nonetheless subject to statutory requirements, or to take measuresto ensure the retention of entitlements (by analogy with Directive 98/49/EC(
2) on supplementary pension
schemes);
16. Demands that steps be taken to examine the urgent need to address the health problems facing
citizens of one of the EU Member States when they are visiting the territory of another Member State of
the EU as tourists or for other reasons and calls also for a uniform minimum medical and hospital care
cover for citizens residing in a country other than that in which they are insured;
17. Calls on the Commission to set up an annual forum which would assemble the representatives of
the Member States and the Community institutions, insurers and providers of medical services and con-sumer organisations with a view to studying the changes and adjustments required for the development of
health and health protection systems;
(1) OJ L 149, 5.7.1971, p. 2.
(2) OJ L 209, 25.7.1998, p. 46.8.8.2001 EN C 223/343 Official Journal of the European Communities
Thursday 16 November 2000
18. While welcoming the development of a single market in supplementary private healthcare, believes
that all other health protection should be a matter for Member States rather than the European Union;
affirms, in particular, that publicly funded healthcare systems should remain within the exclusive compe-
tence of the Member States and believes that generous public financing of such healthcare systems isessential for the health of the people of Europe;
19. Instructs its President to forward this resolution to the Commission and the Council,C 223/344 EN 8.8.2001 Official Journal of the European Communities
Thursday 16 November 2000