WRITTEN QUESTION P-2496/99 by Raffaele Costa (PPE-DE) to the Commission. Measures to facilitate Community-wide health care.
Date: 1999-12-16
Institutions: European Parliament, Provisional data
Subjects: European social policy, competence of the Member States, freedom to provide services, health care, legal basis

C 303 E/68

Official Journal of the European Communities

EN

24.10.2000

Answer given by Mrs de Palacio on behalf of the Commission

(1 February 2000)

As the guardian of the Community(cid:146)s legal system, the Commission must ensure that the treaty, and the
action taken by the institutions in pursuance thereof, is properly implemented. Those activities relate not
only to the transposition, per se, of the directives into national law, but also compliance by national laws
with the substance of the rules applying at Community level.

Article 18 of Council Directive 96/67/EC of 15 October 1996 (1) on access to the ground-handling market
at Community airports provides that Member States may take the necessary measures to ensure protection
of the rights of workers and respect for the environment, but also that such action must be taken without
prejudice to the application of the directive, and subject to the other provisions of Community law. The
aim of the directive is to ensure free access to the market for the supply of ground-handling services in
terms both of self-handling and the provision of services by third-parties. That opening is being conducted
in stages, in accordance with the timetable laid down by Article 1 of the Directive. In order to meet these
conditions, the provisions of the Ministerial order transposing the directive must not prevent the principle
of free access being applied by introducing restrictive rules solely for the sector concerned.

The provisions of the decree transposing the directive into national law and enabling extensive discre-
tionary powers to be conferred on the authorities, during the selection procedure, in order to restrict that
free market access takes no account of the aims of the directive as set out, in particular, in recitals 14 and
15 thereof, and would seem to infringe the provisions of Articles 6, 7, 11, 14 and 18. As provided for in
Article 226 (former Article 169) of the EC Treaty, the Commission is therefore required to take any action
needed in order to ensure that the Community standard is transposed and implemented correctly. The
letter to the Italian authorities referred to was written precisely in order to ensure a consistency of this
kind.

(1) OJ L 272, 25.10.1996.

(2000/C 303 E/060)

WRITTEN QUESTION P-2496/99

by Raffaele Costa (PPE-DE) to the Commission

(16 December 1999)

Subject: Measures to facilitate Community-wide health care

Everyone knows that individual Member States have raised objections to the proposal to authorise their
citizens to travel abroad for treatment to be reimbursed by the patient(cid:146)s country of origin when such
treatment is not really feasible in that country.

However, everyone also knows that people are often prevented from making such (cid:145)journeys of hope(cid:146) for
bureaucratic and mere financial reasons, even when the journeys are perfectly justified.

Can the Commission say what can be done at European level to ensure that Community citizens are
allowed, or at least enabled, to obtain treatment, without financial burdens or at least on acceptable terms
B and hence without excessive expense (as is the case at present) (cid:129) in all Community hospitals?

Might it be possible for a European fund to be set up for this purpose?

Answer given by Mrs Diamantopoulou on behalf of the Commission

(17 January 2000)

The question concerns the possibility for Community citizens of travelling to a Member State other than
their country of residence to obtain medical treatment. This possibility depends on two legal bases.

24.10.2000

EN

Official Journal of the European Communities

C 303 E/69

In the field of social security within the meaning of Article 42 (ex Article 51) of the EC Treaty, the rules
on the coordination of the national social security systems are set out in Council Regulation (EEC)
No 1408/71 of 14 June 1971 on the application of social security schemes to employed persons, to self-
employed persons and to members of their family moving within the Community (1) and its implementing
Regulation (EEC) No 574/72 (2). Article 22(1)(c) of Regulation (EEC) No 1408/71 contains precise rules on
the situation that arises when a person insured in one Member State visits another Member State with the
express purpose of obtaining (cid:145)planned(cid:146) medical treatment and medical products and provides that the
person concerned must obtain a prior authorisation from the sickness fund under which he is insured with
a view to reimbursement of all the costs incurred. This authorisation is attested by Form E 112. In this
case Article 22(2) of Regulation (EEC) 1408/71 provides that this authorisation (cid:145)may not be refused where
the treatment in question is among the benefits provided for by the legislation of the Member State on
whose territory the person concerned resided and where he cannot be given such treatment within the
time normally necessary for obtaining the treatment in question in the Member State of residence taking
account of his current state of health and the probable course of the disease.(cid:146) Hence, under this rule, the
authorisation system concerned requires Member States to issue the authorisation in precise cases, while
leaving them completely free to choose in other cases. Besides, pursuant to these Community rules,
(cid:145)planned(cid:146) treatment is always given by the institution at the place of stay (cid:145)provided for by the legislation(cid:146)
applied by that institution and the costs are borne by the Member State.

As regards the freedoms of the internal market, and in particular the free movement of goods provided for
in Article 28 (ex Article 30) of the EC Treaty and the freedom to provide services provided for in Article
49 (ex Article 59) of the EC Treaty, the Court of Justice has adjudicated in the context of two joined
preliminary rulings (Kohll and Decker, C-158/96 and C-120/95), dated 28 April 1998. The Court found
that national rules in the field of social security may not override the freedoms of the internal market and
ruled that the prior authorisation requirement for the reimbursement of spectacles and dental treatment
infringes Community law (guaranteeing the free movement of goods and the freedom to provide services)
whenever no authorisation is required in internal situations. There exists a right to equal treatment without
a distinction being made between an internal and a cross-border situation. As opposed to Article 22 of
Regulation (EEC) No 1408/71, equal treatment allows the Member State in which the person is insured to
maintain all
to
reimbursement if the Member State of insurance does not enshrine such a right within its own jurisdiction
nor a right to reimbursement of all the costs incurred in connection with medical treatment. On the other
hand, permission for treatment by social security institutions cannot be refused simply because there is a
cross-border situation. However, the Court has recognised the possibility of issuing a refusal on grounds of
public health within the meaning of Articles 30 (ex Article 36) and 46 (ex Article 56) of the EC Treaty, in
so far as the maintenance of a treatment facility or medical services on national territory is essential for
public health and even the survival of the population of the Member State concerned. Likewise, the Court
has allowed restrictions when there is a risk of seriously undermining the financial balance of the social
security system but not as proven by the Member State of insurance.

the restrictions to its rules; hence equal

includes neither a direct right

treatment

Hence, given the Community rules pertaining to the internal market and social security, Community law
does not currently entitle the Community to take measures affecting the funding of medical or hospital
treatment in the Member States. Funding is a matter for the Member States. Hence, it is not possible to
create specific funds in this context.

(1) OJ L 149, 5.7.1971.
(2) OJ L 74, 27.3.1972.

(2000/C 303 E/061)

WRITTEN QUESTION P-2498/99

by Ian Hudghton (Verts/ALE) to the Commission

(16 December 1999)

Subject: Compensation for the compulsory slaughter of salmon in accordance with EC law

Can the Commission confirm that a scheme exists to provide for prompt, adequate and effective
compensation for the compulsory slaughter of salmon in farms infected with ISA, in accordance with
Directive 93/53/EEC (1)
introducing minimum Community measures for the control of certain fish
diseases?