EN Official Journal of the European Union CE 88/244

(2004/C 88 E/0247)

WRITTEN QUESTION E-0908/04

by Paolo Bartolozzi (PPE-DE) to the Commission

(24 March 2004)

Subject: Services of general interest

A motion for a resolution was tabled in the European Parliament on 14 January 2004 on the Commission's Green Paper on services of general interest (1).

In this document the Commission includes health among non-economic services of general interest, and defines the difference between economic and non-economic services as fundamental, since the two categories are not subject to the same Treaty provisions.

It is clear that ‘the future of non-economic services of general interest’, including health or social services, ‘raises issues on a European scale, such as the content of the European model of society’.

It should be borne in mind that:

— the health sector is characterised by ethical and social values, because its aim is to safeguard health as an inalienable subjective right, but this does not mean that the services designed to provide these safeguards are of a non-economic nature as far as their organisation and management are concerned;

— ‘economic and non-economic services can co-exist within the same sector’ not least because ‘the distinction between economic and non-economic activities has been dynamic and evolving’;

— the common objective of the reforms carried out in many Member States has been to safeguard the principles of welfare as a ‘choice on the part of society’, involving the introduction of mechanisms creating competition between a number of public and private service providers among which the public is completely free to choose.

For these reasons the inclusion of health among non-economic services of general interest, which are ‘not subject to specific Community rules, nor are they covered by the internal market (…) rules of the Treaty’, seems reductive.

Can the Commission say:

— why health is not included among economic services of general interest, since such services are subject to common obligations which must be ensured for the public, such as universality, continuity, quality, accessibility and security;

— if health is thus excluded from the process of implementing the internal market, will this not mean abandoning the objective, set by many Member States, of achieving the advantages of market efficiency without neglecting social justice, guaranteed by State guidance, control and responsibility?

— On what basis is health excluded from the general approach outlined in the Commission's Communication ‘An internal market strategy for services’? Would not the recognition of health as an economic service of general interest — hence subject to the favourable influence of competition on the basis of quality — promote the successful pursuit of the Community objective of a ‘high level of health protection’?

Answer given by Mr Byrne on behalf of the Commission

(30 April 2004)

Health systems meeting public objectives are in principle services of general interest, whether economic or not. However, it is up to Member States to define the public service obligations concerned, as part of their overall responsibility for the organisation of health services and medical care. The differences in organisation of the national health sectors result in different legal positions with regard to Community law and provisions concerning services of general interest. In this respect it may be relevant to distinguish between the provision of health services and the systems put in place for their financing. Health services provided for remuneration are an economic activity within the meaning of the EC Treaty, regardless of how they are financed (see C-158/96 Kohll and C-157/99 Smits-Peerbooms). On the other hand, solidarity-based, non-profit-making social security funds are not undertakings within the meaning of the competition rules of the EC Treaty (see C-159/91 and C-160/91 Poucet-Pistre and, more recently on 16 March 2004, C-264/01, C-306/01, C-354/01 and C-355/01 AOK Bundesverband). However, exactly how different national health systems fit into these categories will depend on their precise organisation and status.

Nevertheless, all health systems throughout the Union share common values of accessibility, quality and financial sustainability, despite their diversity. Moreover, the potential advantages of mobility and cooperation across Europe are open to patients, providers and those responsible for health systems. The provisions on the coordination of social security systems (currently being simplified) and the forthcoming European health insurance card provide an effective means for patients to access healthcare throughout the Union and be reimbursed. The Commission has also proposed a directive on services in the internal market (2) which will help to facilitate cross-border provision of services, and which includes specific clarification with regard to the reimbursement of healthcare costs.

Health ministers, together with other health stakeholders, have come together in a high level process of reflection on patient mobility and healthcare developments in the European Union. The report established by this reflection group contains nineteen recommendations regarding European cooperation to promote better use of resources; information for patients, professionals and providers; access to and quality of care; an appropriate response to enlargement through investment in health; and the reconciliation of national objectives with European obligations. The Commission has responded to these recommendations by proposing the extension of the open method of coordination to healthcare and long-term care. Taken together, all these different initiatives form an integrated strategy to enable patients to exercise their rights under European law to healthcare in other Member States and to facilitate European cooperation between health systems whilst respecting the responsibilities of the Member States for the organisation and delivery of health services and medical care.

(1) COM(2003)270.

(2) COM(2004) 2 final.