EN Official Journal of the European Union CE 70/1

(2004/C 70 E/002)

WRITTEN QUESTION E-2577/02

by Kathleen Van Brempt (PSE) to the Commission

(16 September 2002)

Subject: Deficit in the sickness insurance scheme for European officials

The sickness insurance scheme under which 45 000 European officials are covered has just decided to reimburse the cost of the impotence pill Viagra on certain conditions. It is the first sickness insurance scheme in Europe to do so. According to the French newspaper ‘Le Monde’, the decision was taken at a time when the scheme, which is two-thirds financed by the EU, is showing a deficit for the first time in its history.

What is the size of the deficit shown by the sickness insurance scheme for European officials to which Le Monde refers?

What are the costs to the sickness insurance scheme of providing reimbursement for Viagra?

Does the Commission consider it appropriate to allow reimbursement for Viagra pills at a time when the sickness insurance scheme is showing a deficit?

How does the Commission envisage making the sickness insurance scheme budget balance again?

Joint answer

to Written Questions E-2576/02 and E-2577/02

given by Mr Kinnock on behalf of the Commission

(28 October 2002)

The Honourable Members Questions both refer to an article published in ‘Le Monde’ on 9 August 2002. This article, like several subsequent publications in other newspapers, appeared to be based on a series of imprecise or incorrect statements concerning the Joint Sickness Insurance Scheme (JSIS). Even though reporting some factual information, the newspaper articles draw misleading or wrong conclusions.

In 2002 the JSIS accounted for expenditure of EUR 128,2 million and receipts of EUR 134,5 million, the overall result thus was a surplus of EUR 6,3 million. This surplus, as in all preceding years since 1991, was added to the financial reserve. The reserve is currently equivalent to some 12,5 months' expenditure.

A more detailed analysis shows that, out of the total of EUR 134,5 million, some EUR 126,6 million was recovered from contributions and the remaining EUR 7,9 million represents interest received on the financial reserve. The ‘deficit’ of EUR 1,6 million to which ‘Le Monde’ referred is the difference between contributions and expenditure, not income and expenditure.

A total of 86 000 people are insured under JSIS. At present, applications for reimbursement of purchase costs of Viagra have been accepted, after obligatory consultation of the Medical Officer, in less than 30 cases — 0,035 % of the total number of persons insured.

Based on the existing cases and on the assumption that in each case the maximum number of prescribed tablets will be consumed, the total annual expenditure will be approximately EUR 20 000 — 0,015 % of the total annual income of the JSIS.

Medical, technical and pharmaceutical progress means that the JSIS — like any other public or private insurance scheme — has to regularly review and update the range of services and products it covers. In the early phase of the commercialisation of Viagra, purchase of the product by persons in the insurance scheme was not reimbursed by the JSIS. However, certain national schemes (e.g. the National Health Service in the United Kingdom in early 1999), decided to recognise it. In other Member States (like Germany), reimbursement followed individual court rulings. In March 2002, the Sickness Insurance Management Committee gave a favourable opinion in the case of a former official requesting the reimbursement of Viagra after a major surgical operation. Subsequently, general rules were adapted. Claims that the JSIS is the first European health system to provide Viagra are therefore not true.

The regular revision of the services and products covered by the JSIS is not directly linked to the financial situation of the scheme. Instead, it is intended to ensure that the scheme provides its members with access to treatments considered effective and cost-effective.

Furthermore, many medical treatments are provided with the intention of giving relief from conditions which have a seriously deleterious effect on quality of life, rather than simply to prolong it.

In severe cases, erectile dysfunction is a distressing condition which can have a significant psychological effect on those suffering from it. Other treatments not involving Viagra are available under the JSIS, but since Viagra appears to be a more effective treatment in some circumstances, it is appropriate for the JSIS to provide it.

The maximum number of reimbursable tablets is, however, limited and may be granted only in the rare cases where erectile dysfunction is a direct consequence of a serious illness (e.g severe diabetes) or after radical prostatectomy. Every case has to be presented individually to the Medical Officer and reimbursement is strictly limited to the medical conditions described above.

As explained above, the JSIS is currently showing an overall surplus (EUR 6,3 million in 2001), not a deficit. The quoted ‘deficit’ of EUR 1,6 million is limited to the purely ‘operational’ side. The medium-term financial forecast of the scheme prepared for the JSIS Annual Report in 2001 suggests that, as a consequence of the changing age structure, the operational deficit is likely to continue to grow. However, until 2010-2013 (depending on the underlying assumptions) the operational loss should be clearly offset by the financial revenue and consequently the financial reserve will continue to grow until that date. Nevertheless, the financial forecast is reviewed annually, and if a financial imbalance of the scheme is detected, measures will be proposed to rebalance the situation in ways that are similar to those adopted in 1990 following the significant deficits experienced in the late eighties.

The range of benefits offered by health insurance varies considerably between Member States, between types of insurance, and within the same insurance type. Community provisions on social security do not provide for harmonisation, but for simple co-ordination of the national systems. Every Member State is free to determine the details of its national social security scheme, including which benefits are to be granted and under what conditions.