WRITTEN QUESTION P-0892/02

by Jules Maaten (ELDR) to the Commission

(22 March 2002)

Subject: Cross-border contracting of general practitioners

Is the Commission aware of the report entitled Unhappy patients want a German doctor, which appeared in the 6 February 2002 edition of the De Limburger newspaper, and of the article entitled Patient must be able to shop around in the EU, which was published by the Dutch MP Frans Weekers in the 6 February 2002 edition of the Trouw newspaper?

Is the Commission aware that, under Dutch health insurance legislation, health insurance funds may contract only Dutch doctors, and does it consider such a nationality requirement to be an infringement of EU law?

Does the Commission think that the cross-border contracting of general practitioners could make the shortage of such doctors in border areas more acute and is it prepared to introduce further legislation in this field? If so, in what form and within what period of time?

Answer given by Mr Bolkestein on behalf of the Commission

(26 April 2002)

The Commission is aware of the fact that the delivery of health services within the European Union has received considerable media coverage in recent months on account of the judgments delivered on 12 July 2001 by the Court of Justice in the Smits and Peerbooms (C-157/99) and Vanbraeckel (C-368/98) cases. In these judgments and in those delivered on 28 April in the Kohll (C-158/96) and Decker (C-120/95) cases, the Court ruled on the question of the reimbursement of medical expenses incurred in a Member State other than the Member State of registration.

In these judgments, the Court confirmed that European law does not detract from the Member States' responsibility for organising their systems of social security and that, in the absence of harmonisation at Community level, it is for the legislation of each Member State to determine, first, the conditions concerning the right or duty to be insured with a social security scheme, and, second, the conditions for entitlement to benefits.

In order to protect migrant workers from the negative effects which the application of the different national laws in the field of social security might have, Regulation 1408/71 coordinates the national social security schemes. In the field of health care, it provides for different scenarios in which the costs for health care obtained in another Member State can be reimbursed. This regulation does not, however, contain any provision regarding the contracting of practitioners established outside the Member State concerned.

The Court pointed out in the above-mentioned judgments that, other than in the scenarios mentioned by this regulation, the Member States must observe Community law in exercising their responsibility to organise their social security systems and, in particular, the principle of the freedom to provide services set out in Article 49 of the Treaty. The Court did in fact point out that medical activities are indeed services under the terms of this provision.

This then is the context within which the Commission must analyse any law such as that mentioned by the Honourable Member a law which in this case it knew nothing about. It should be noted that it is, in the first instance, up to the Member States to ensure that their legislation complies with Community law as interpreted by the Court of Justice. In this respect and bearing in mind the implications and scope of Community case law, the Commission wishes to initiate a dialogue with the Member States, particularly with a view to discussing intended measures. It is only once this consultation has taken place that the Commission will be able to assess whether a Community instrument is appropriate.

The two questions asked by the Honourable Member will be examined within this approach.