WRITTEN QUESTION E-1524/03

by Erik Meijer (GUE/NGL) to the Commission

(6 May 2003)

Subject: Compulsory payment of contributions for health care in a Member State other than the state of residence and the health care services used

1. Is the Commission aware that the free movement of persons and freedom of establishment has resulted in many people no longer being dependent on residence in their Member State of origin for their income, including many pensioners who settle in areas with warm climates and attractive recreational facilities, such as the coastal areas of Spain?

2. Is this influx of new residents resulting in a relatively heavy burden being imposed on the Spanish social security system, which has to meet the needs of local residents on low incomes with few doctors and facilities, thus resulting in growing waiting lists?

3. Can the Commission confirm that EU Regulation (EEC) 1408/71(1) requires persons in receipt of a pension or social benefit from their Member State of origin to pay contributions in that State to cover their entitlement to health services in another Member State where they have chosen to live? Does this mean that people may be required to pay for a much broader or limited package of provisions than is available in the Member State where they live, so that there is no relation

between the level of contributions and the range of services to which they are entitled? To what extent is this compatible with the principle that people within the EU must not be disadvantaged from the point of view of the free movement of persons and freedom of establishment?

4. What would the implications be if some of the provisions that are now covered by the Exceptional Medical Expenses Act (AWBZ) in the Netherlands were transferred to the Sickness Insurance Fund, as a result of which the remaining AWBZ contribution would mainly or primarily cover services not available in Spain? Would it not be better if they could pay for additional provisions in Spain instead of in the Netherlands?

5. What measures is the Commission taking to ensure that the pressure of foreign residents on the Spanish social security system does not become too great and prevent a large group of insured persons from continuously complaining about high contributions and limited health care services?

(1) OJ L 149, 5.7.1971, p. 2.

Answer given by Mrs Diamantopoulou on behalf of the Commission

(6 June 2003)

The Commission would inform the Honourable Member that, in the absence of harmonisation of social security systems across Europe, Regulation (EEC) No 1408/71(1) set up a system of coordination of national social security schemes in order to provide optimum social security protection for persons moving within the Union.

Regulation (EEC) No 1408/71 contains provisions entitling persons residing on the territory of another Member State than that in which they are insured to obtain medical treatment there.

As a general rule, the principles of Regulation (EEC) No 1408/71 provide that the health care shall be given in accordance with the legislation of the Member State in which the person concerned resides, as if the person was insured in that country. This system is designed to ensure equality of treatment for persons residing on the territory of a Member State. Persons residing in a Member State other than the State that pays their pension will thus be entitled to health care in the Member State of residence in accordance with the legislation of that State, as if they were insured there. In order to obtain health care in the country of residence, the pensioner registers with the institution of the country of residence, by means of a form certifying that he/she is entitled to health care. Once the pensioner is registered with the institution of the country residence, the authorities of that country can take him/her into account when planning what medical resources they need.

Regulation (EEC) No 1408/71 also contains provisions determining which institution shall bear the costs of health care provided to a pensioner. If the pensioner has a pension from a single Member State other than that in which he/she resides, it is the institution of the country responsible for paying the pension that bears the costs of health care. The Regulation establishes how the accounts are settled between institutions: the institution of the Member State of residence receives from the institution of the Member State responsible for the pension a fixed amount (at present 80 % of the annual average health care costs for a pensioner in the country of residence) which covers all the health care provided to the pensioner.

In return, the Regulation provides that the institution which bears the health care costs may deduct from the pension payable by it any deductions of contributions provided for by its country's legislation.

In certain situations, these rules may indeed result in a pensioner paying relatively high social security contributions in relation to the services he/she can claim in the country of residence. However, the reverse can also be true.

The Commission can inform the Honourable Member that a partial solution to this problem has been found during the negotiations on the proposal to simplify and modernise Regulation (EEC) No 1408/71(2). At its meeting of 3 December 2002, the Council reached an agreement on a general orientation for the chapter relating to sickness and maternity, whereby the pensioner may also obtain health care in

the Member State of the institution which pays the costs of the health care for the pensioner (and to which he may pay social security contributions), provided that this Member State has opted for this solution and is listed in an Annex included for this purpose in the Regulation.

(1) Regulation (EEC) No 1408/71 of the Council of 14 June 1971 on the application of social security schemes to employed persons and their families moving within the Community, last updated by Council Regulation (EC) No 118/97 of 2 December 1996 OJ L 28, 30.1.1997.

(2) Proposal for a Regulation of the European Parliament and of the Council on coordination of social security systems OJ C 38, 12.2.1999.