WRITTEN QUESTION P-0892/02 by Jules Maaten (ELDR) to the Commission. Cross-border contracting of general practitioners.
Date: 2002-03-22
Institutions: European Parliament, Provisional data
Subjects: competence of the Member States, freedom to provide services, health insurance, physician, social security, social security legislation

C 172 E/226

Official Journal of the European Communities

EN

18.7.2002

Answer given by Mr Prodi on behalf of the Commission

(18 April 2002)

It is Commission policy not to comment on public statements by politicians in the Member States.

(2002/C 172 E/244)

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
the judgments delivered on
received considerable media coverage in recent months on account of
12 July 2001 by the Court of Justice in the Smits and Peerbooms (C-157/99) and Vanbraeckel (C-368/98)
cases.
(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 and in those delivered on 28 April

in the Kohll

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,
first, the conditions
it is for the legislation of each Member State to determine,
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.

18.7.2002

EN

Official Journal of the European Communities

C 172 E/227

This then is the context within which the Commission must analyse any law such as that mentioned by
the Honourable Member B 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.

(2002/C 172 E/245)

WRITTEN QUESTION P-0933/02

by Pat Gallagher (UEN) to the Commission

(26 March 2002)

Subject: Member State legislation on health and safety for the self-employed

Given that in approximately half the Member States the self-employed, while covered by the Framework
Directive for health and safety, are not covered in the individual Member State to the extent that national
legislation on health and safety does not include the self-employed, will the Commission give priority to
proposing an EU-wide solution which ensures that all workers in the Internal Market are ensured of equal
treatment in relation to health and safety in the workplace, thus improving conditions for labour mobility
and contributing to a more effective Internal Market and dynamic EU economy?

Answer given by Mrs Diamantopoulou on behalf of the Commission

(23 April 2002)

The Commission shares the view of the Honourable Member on the importance of recognising the need
for protection of the health and safety at work of the self-employed.

However, the Framework Council Directive 89/391/EEC of 12 June 1989 on the introduction of measures
to encourage improvements in the safety and health of workers at work (1) does not cover the self-
employed. In fact, its Article 3 defines the term ‘worker’ as used in the Directive as ‘any person employed
by an employer’. The result is that this provision clearly excludes self-employed persons from the scope of
the Directive.

The Commission has however recently adopted a proposal for a Council Recommendation concerning the
legislation governing health and safety at work to self-employed workers (2). The
application of
Recommendation is a non-binding instrument aimed at achieving a minimum level of protection for self-
employed workers in accordance with the subsidiarity principle. The main issues dealt with in the
Recommendation are recognition of the rights of self-employed workers, information, training, and health
surveillance.

(1) OJ L 183, 29.6.1989.
(2) COM(2002) 166 final.

(2002/C 172 E/246)

WRITTEN QUESTION P-0945/02

by Francesco Fiori (PPE-DE) to the Commission

Subject: Foal Levy imposed on breeders of thoroughbred horses

(28 March 2002)

The purpose of the European agricultural model which was laid down in Agenda 2000 and which is
currently being revised by the European Union is to create an agricultural sector which is competitive and
not over-subsidised. There is no justification for making the breeders of thoroughbred horses pay a levy