Opinion of the European Economic and Social Committee On "Healthcare"
Date: 2003-07-16
Institutions: European Economic and Social Committee
Subjects: EU Member State, health care, health care system, health policy

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3.11. When setting new harmonised limits,
the Com-
mission should strive to respect the Codex MRLs under the
WTO rules introduced in the late 1990s. Many of these are
not acceptable to the Community, and each of them must be
subject to individual critical examination. The EESC would

stress that these international requirements should not force
the Community into making its own requirements flexible,
and calls upon the European Commission to strive to maintain
the existing high level of health protection.

Brussels, 16 July 2003.

The President

of the European Economic and Social Committee

Roger BRIESCH

Opinion of the European Economic and Social Committee On ‘Healthcare’

(2003/C 234/11)

On 21 January 2003, in accordance with Rule 29(2) of the Rules of Procedure, the Economic and Social
Committee decided to draft an opinion on ‘Healthcare’.

The Section for Employment, Social Affairs and Citizenship, responsible for preparing the Committee’s
work on the subject, adopted its opinion on 30 June 2003. The rapporteur was Mr Bedossa.

At its 401st Plenary Session on 16 and 17 July 2003 (meeting of 16 July), the European Economic and
Social Committee adopted this opinion by 61 votes in favour, 5 votes against and 6 abstentions.

1.

Introduction

in terms of organising healthcare and in terms of
responsibility.

1.1.
The Commission Communication of December
2001 (1), the follow-up to the initiative approved at the Lisbon
European Council of March 2000, and the initial report for
the 2002 European Council boldly address one of the most
difficult aspects, after pensions, involved in building a social
Europe in accordance with the values enshrined in the Charter
of Fundamental Rights.

1.1.1.
Health is often defined as a fundamental asset for
society. This is equally applicable to each individual citizen,
family, and nation.

— Naturally, the approach taken by each individual differs,
as does the approach taken by EU Member States, both

— However, the EU as a whole must tackle a series of
challenges. A solid basis of understanding is needed to
find common, appropriate responses to such challenges,
whilst respecting existing diversity.

— The definition given by the World Health Organisation
(WHO) states that health is a state of complete physical,
mental and social well-being of each individual.

— Healthcare is not limited to treating pathologies, but
must more generally encompass individual and collective
efforts at prevention and promotion of aptitudes and
conditions.

( 1) COM(2001) 723 final on the Future of healthcare and care for the
elderly: guaranteeing accessibility, quality and financial viability.

— Being a fundamental asset, health cannot be considered
solely in terms of social expenditure and latent economic
difficulties.

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It
is an investment and represents a vital, efficient and
constructive sector of the economy generating significant value
added in societal development, as well as fostering growth.

Access without discrimination, quality and the finan-
1.1.2.
cial viability of healthcare systems — especially those intended
for the elderly and socially disadvantaged groups — present a
series of challenges and problems common to all EU Member
States, pre- and post-enlargement (a fortiori). Their responses
to these have differed, but the principles of solidarity, equality
and universality have been upheld by all of them.

1.1.3.
It is true that the demand in Europe on healthcare
systems and available services has continued to grow over the
last two decades. Responding to this demand has always been
a matter for each individual country, acting against an
increasingly and at times overly sensitive political backdrop.
Whilst the challenges to develop healthcare systems apply to
all Member States, they will be even more pronounced in the
candidate countries in 2004. Undoubtedly, the issues at stake
are considerable for all Member States and, more importantly,
have become inter-connected.

1.3.1.
However, it should be noted that whilst the rate of
growth of the health expenditure/GNP ratio has slowed down,
the budget for this sector remains high and continues to rise.
Public opinion has forced an examination into whether this
continuous growth tallies with actual results for consumers,
i.e. whether it translates into the benefits of better public and
individual health that they expect. The continued increase in
spending is nowhere accompanied by a reduction in inequaliti-
es, especially socio-occupational, with respect to quality of life
and life expectancy. The objective of reducing these inequalities
should become the main indicator for healthcare policies in
Europe and the stimulus for the changes in strategy that it will
require.

At present, there are many key factors determining

1.4.
health, which vary between the Member States.

Approximately ten essential factors exert a decisive influence
on policy:

1.4.1. D e m o g r a p h i c e f f e c t s

1.2.

This draft opinion aims to achieve several objectives:

1.4.1.1.
on health expenditure.

Age and the ageing population inevitably impact

— to promote initiatives to boost knowledge, exchanges and
comparison between the various European healthcare
systems;

— to support the steps taken by the EU institutions, notably
by the European Commission, to pursue specific, more
effective initiatives in the field of healthcare;

1.4.1.2. Many recent studies carried out in seven industrial-
ised countries appear to confirm that, over the last decade,
demographics have had an impact on the trend in spending
equivalent to 1 % in volume terms. This rise is due to in equal
measure to the overall increase in population and ageing.

— to encourage initiatives by EU socio-professional interest

groups and to enhance their joint policies.

Therefore, although the breakdown of this impact
1.4.1.3.
differs between countries,
its influence is clear. However,
traditional demographic values should not be the only aspects
to be taken into account.

At all events, this draft opinion is intended to support and
complement the action taken by the European Commission in
its 2003-2008 public health programme.

1.4.1.4.
Consideration should be given to factors such as
that dubbed the ‘generation effect’ by experts, whereby recent
generations of healthcare users are accustomed to higher levels
of healthcare provision than previous generations who did not
always have access to healthcare equivalent to that on offer
today.

1.3.
Since the Treaty of Rome, the proportion of healthcare
consumption expressed in terms of national wealth has risen
at an annual average of 2,2 % more than GNP in the developed
countries as a whole, especially in the European Union,
increasing from 4 % of GDP in 1960 to over 8 % of GDP today
(Source: OECD, 2002), even if this rise appears to have slowed
down recently.

1.4.1.5.
It is quite conceivable that these factors may lead
to a multiplier effect on healthcare expenditure occurring as
these generations get older if people begin life with proper
access to healthcare and continue to benefit from it throughout
their active life .

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1.4.2.

P e r c e p t i o n s o f h e a l t h c a r e

1.4.2.1.
Different attitudes to health exert a considerable
influence on the expectations and behaviour of healthcare
users. Health is perceived as an absolute good, a citizen’s right
which the relevant authorities must safeguard, and this entails
a rise in costs to meet these expectations, and the risk of losing
political consensus whenever it is planned to reduce the scope
of free or almost free healthcare for budgetary reasons.

1.4.5.2.
Thus, there has been a growing trend to treat social
problems as medical problems. Whilst the approach to this
it
factor is complex and necessitates further examination,
should not be overlooked, especially since European society is
increasingly demanding the use of the precautionary principle.
All
insecurity (unemployment, precarious
situations, stress, discrimination, pollution etc.) increasingly
affect the state of health and healthcare spending, and create a
growing demand to apply the precautionary principle.

types of social

1.4.3.

E p i d e m i o l o g y

1.4.3.1.
Healthcare is currently facing new challenges
associated in part with new pandemics of certain contagious
diseases and new manifestations of known illnesses that are
no less difficult to treat. The impact of these on costs and
healthcare organisation is not easy to quantify.

1.4.6.

E n v i r o n m e n t a l a n d d i e t a r y n e e d s

1.4.6.1.
The key role played by the environment, in the
broadest sense of the term, on health expenditure is no longer
questioned.

1.4.6.2.
However, it is already clear from a Europe-wide
study carried out as part of the programme on atmospheric
pollution and health that even a very modest reduction in
atmospheric pollution levels has a beneficial effect upon public
health and justifies implementing preventive measures.

1.4.4.

E c o n o m i c g r o w t h

1.4.6.3.
Similarly, the effects of consuming high-risk prod-
ucts, such as tobacco, drugs and alcohol, must be taken into
account.

1.4.4.1.
Several studies have demonstrated the link between
economic growth and healthcare expenditure, i.e. the dispro-
portionate increase in healthcare expenditure that accompanies
rising income levels. This correlation at macroeconomic level
is not matched where cyclical trends are concerned: there has
not been a significant decrease in healthcare expenditure, even
at times of economic slowdown.

1.4.6.4.
The quality of food is a crucial factor — poor
eating habits are at the root of a series of processes that lead
to increased sickness and even mortality rates; they are for
instance the prime cause of death from cancer. This is of
particular concern since it affects the whole population,
especially young people (obesity).

1.4.4.2.
This shows a degree of disassociation between
demand for healthcare provision and the state of the economy.
It contributes to the difficulties in reducing health spending
encountered by countries that are seeking to place greater
responsibility on the medical profession and consumers.

1.4.5.

S o c i a l o r g a n i s a t i o n

1.4.7. T e c h n i c a l p r o g r e s s

1.4.7.1.
Technical progress is an ambivalent factor, as it
can have positive or negative effects on healthcare expenditure.
Nonetheless, technical progress is an inescapable fact.

It should be noted that new treatments often
1.4.7.2.
highlight ailments which were previously ‘unheard of’ because
no treatment was available.

1.4.5.1.
Changing lifestyles, the organisation of family life,
changes in the workplace and the increase in precarious
employment are drastically changing the shape of traditional
healthcare systems.

1.4.7.3.
vations, whether in drugs or examination techniques.

This phenomenon occurs especially with inno-

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Of course,

1.4.7.4.
diagnostic or treatment
techniques.

it is important to ensure that new
techniques do not duplicate old

1.4.7.5.
Therefore the use of appropriate techniques and
replacement of old techniques should be encouraged, whilst
noting that this is often hindered by socio-cultural consider-
ations, sometimes generated by restrictive behaviour on the
part of the healthcare profession.

1.4.7.6.
Radiology techniques can be taken as an example.
At present, traditional radiography is still used alongside scans,
MRI (magnetic resonance imaging) and, most recently, PET
(position emission tomography).

1.4.8.

S o c i o - c u l t u r a l b e h a v i o u r p a t t e r n s

1.4.8.1.
able influence on healthcare expenditure.

Socio-cultural behaviour patterns have a consider-

1.4.8.2.
mostly concern primary prevention.

Collective and individual actions in this domain

1.4.9.2. Moreover, whilst the demand for healthcare con-
tinues to grow, it does not always represent objective need and
is influenced by the quality and quantity of healthcare supply.

1.4.10. T h e i m p a c t o f s o c i a l w e l f a r e

1.4.10.1.
The increasing demand for social and medical
cover puts constant pressure on social welfare systems. This
factor, closely linked with the previous one is concerned more
with healthcare demand, which it more or less meets, than
healthcare supply.

1.4.10.2.
according to its own criteria.

Each Member State organises its welfare system

The increase in internal EU travel raises questions
1.4.10.3.
which require in-depth knowledge of each welfare system and
which, like it or not, inevitably lead to comparisons.

1.4.10.4. Many questions have arisen as a result of the free
movement of patients. First we need to know what the present
situation is and how it might evolve.

1.4.8.3.
The results, while undoubtedly leaving room for
improvement, have been much better in recent years, in line
with progress in evaluation procedures.

2. General comments

1.4.8.4.
Besides smoking, drugs, excessive alcohol con-
sumption and excess weight, traffic accidents, domestic acci-
dents and suicide among young people are significant factors,
as are accidents at work and employment-related diseases.

Such behaviour patterns are linked to a combi-
1.4.8.5.
nation of individual, family and social factors. They often cause
a degree of premature mortality and therefore are particularly
important to identify so that strategies can be adopted to
eliminate risk factors and costs that can easily be avoided.

2.1.
On the basis of the points raised in the previous
section, the European Economic and Social Committee calls
for an urgent and serious debate on the various aspects of
healthcare policy. It considers that the need to boost knowledge
and find common aims in this field should supplement the
debate on the European Convention and take into account the
enlargement of the Union.

2.2.
The Committee is in favour of an ambitious and
necessary work programme on the following broad-based
topics:

— assessment of the impact of various factors on health;

1.4.8.6.
Education and prevention are essential areas for
investment. If work in these areas is conducted with the full
involvement of target groups, especially the most sensitive
groups and the groups most exposed to risks, the benefits in
economic and health terms are proven.

— health in the candidate countries;

— inequalities in access to healthcare;

— ageing and health;

1.4.9. H e a l t h c a r e s u p p l y a n d d e m a n d

— promoting good practices and efficiency in the health

sector.

1.4.9.1.
impact varies between Member States.

These are undoubtedly influential factors, but their

To this end, the Committee supports the approach taken by
the European Commission.

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2.3.
The topics raised by the Commission and the public
health programme are of particular interest for the forth-
coming debates on inter-sectoral policy, patient mobility and
the future of healthcare for the elderly.

— The financial viability of such healthcare policies is an
issue that inevitably means expanding the scope of the
debate, on an ongoing or regular basis, over the coming
years, particularly on resource allocation and provision.

The Committee notes that a comparative analysis of
2.4.
healthcare systems involves complex strategic considerations,
such as the issue of ageing. In all Member States, this issue is
tackled according to family structure, the mobility of elderly
the typology of medical consumption and the
persons,
increased costs of technology.

Each country experiences these issues in different ways,
2.9.
according to their social, cultural and political traditions.
Recognising that these differences exist does not detract from
the scale of the challenge faced by all Member States and
the need to find common approaches involving exchanges,
knowledge and solutions.

Safeguards must be put in place to ensure the quality
2.5.
of healthcare systems, their universal accessibility as far as
possible and their financial sustainability.

2.6.
The Committee also considers that all policy areas
are affected, especially economic and social policies, where
particular attention must focus on the link between health and
employability as well as age and pensions, and that expec-
tations are not always met.

It is worth stressing the importance of the subject — ‘Healthca-
re and care for the elderly; supporting national strategies for
ensuring a high level of social protection’.

3. Challenges and problems

These expectations are threefold:
the support of a well
informed organised civil society, the principle of solidarity —
an essential European value — and an intelligent and effective
prevention policy.

It is clearly very topical and therefore merits strategic dis-
cussion by EU institutions.

Coordination of healthcare policies like pension and

2.7.
retirement policies raises several questions:

— definition of healthcare system;

— the role and importance of supplementary healthcare

schemes;

— the need to differentiate between care, health and comfort.

2.8.

The Committee also lists the following reasons:

— Some people feel that the issue of healthcare, which
involves services of general interest, inevitably entails a
debate on whether healthcare should be defined as a
‘service of general interest’ and to identify the practical
consequences of this.

The case for engaging in such discussion now is

3.1.
supported by several strategic needs:

— The recurring difficulties faced by national public auth-
orities in reducing inequalities in healthcare between the
different population groups and in coping with health
expenditure, whatever the nature, organisation or oper-
ation of healthcare systems.

— The lack of any actual Community competence as regards
the social security systems (except
for coordination
regulations (EEC) No 1408/71 and follow-ups) and
healthcare policies conducted in each Member State does
not mean that the Community should remain indifferent
to conceptual and policy debate on these issues, bearing
in mind the abovementioned comments.

— The prospect of enlargement in 2004 to take in 10
new Member States should encourage the 15 existing
members to further analyse and monitor healthcare
problems.

— Healthcare provision requires trained staff with high
qualifications. The importance of care work, especially
for the elderly, necessitates the introduction of life-long
training programmes.

— The development of EC Court of Justice case law has over
time encouraged wider access to healthcare under supra-
national criteria.

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— The increase in the free movement of people, patients
and professionals due to economic development and
the increasing integration of national markets into the
European Single Market also justifies this discussion.

3.3.2.
Current developments suggest that the balance is
precarious and that a crisis is looming in the present EU as
regards the number of healthcare professionals. So far, the
question of how things will stand in this respect in an enlarged
25-member Europe has hardly been touched upon.

3.2.
New Article 137 of the EC Treaty (Treaty of Nice) only
authorises EU bodies to adopt Community directives setting
minimum requirements in the field of health and social
protection, and requires unanimity.

In the face of the crucial issues which health problems raise
for the European Union, its cohesion and its ability to become
the most competitive knowledge-based economy in the world,
it is the role of the European Economic and Social Committee
to promote increased awareness of these issues.

3.2.1.
Concerning the problem of the free movement of
patients, CoJ case law has made significant progress over time
in paving the way for practical implementation of the right of
free movement of patients and the sick based on the fundamen-
tal freedoms listed in the Community Treaties, and overcoming
the major differences between national healthcare and health-
insurance systems.

3.2.2.
This rationale is illustrated by the fact that more than
three years ago, the European Community launched a review
of Regulation (EC) No 1408/71 (Article 22) with a view to
including health in Articles 49 and 50 of the EC Treaty on the
freedom to provide services.

3.2.3.
Another example of this new state of affairs is the
recent judgement of the EC CoJ (case C-326/00 IKA v Vasileios
Ionnidis). This concerned a Member State’s duty to pay the
medical expenses of a pensioner visiting another Member
State, without payment being made subject to authorisation
and conditions. The reasons adduced for this judgement are
clear: a patient suffering from even a chronic illness must be
able to receive care whilst visiting another Member State.

3.4.
Against this backdrop, there is an urgent need for a
concerted and organised strategy to examine and pre-empt the
problems and to promote the mobility of such professionals
without destabilising the national systems of the new Member
States.

However, under no circumstances will it be possible to make
up for the anticipated shortage of qualified healthcare staff just
by promoting cross-border mobility. In order to meet labour
demand in the health sector on a sustainable basis, flanking
measures are needed to make the caring professions more
attractive and to make it possible for people to stay in such
professions, including job quality, training and promoting the
interchangeability of career paths.

3.4.1.
There is a risk that EU enlargement may lead to
healthcare problems if certain Member States do not treat
developing their healthcare systems as a national priority.

3.4.2.
There is also a risk that social and healthcare
guarantees will be eroded. This could lead to an exodus of
professionals and patients to those Member States with the
best organised healthcare systems. Examples of this abound;
without standing in the way of the principle of free movement,
Member States with the least developed or efficient healthcare
systems should make the budgetary, organisational and quali-
tative commitments needed to ensure that their national health
policy meets the general standards set by the rest of the
Community.

3.3. Mobility applies not only to patients but also to health
professionals. As healthcare systems develop, there is the
threat of a shortfall of medical and paramedical health
professionals.

Faced with such challenges, public authorities and
3.5.
healthcare managers seem overcome by the enormous com-
plexity of the issues at stake and the financial pressures.

3.3.1.
This threat is growing. Some Member States manage
to maintain healthcare provision by relying increasingly on
professionals (doctors, nurses) from countries where there is
still a surplus of such labour.

3.5.1.
No EU country can claim that it has resolved these
problems. All Member States must pursue the common aim of
defining a method of managing and assessing healthcare
needs based on consistent principles making use of flexible
methodologies.

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3.5.2.
It is an irreversible fact that the population is ageing.
According to experts, it accounts for an unavoidable annual
rise in health expenditure of between 0,7 and 1,5 % depending
upon national situations and the provisions for healthcare for
the elderly. Specific policies must be formed to tackle the risk
of sections of the population becoming incapacitated and
dependent.

3.7.2.1.
The need to guarantee broad access to healthcare
for all citizens, a core of rights and services implies going
beyond a simple reform of the minimum standards currently
referred to by European legislation. It has implications for the
credibility of the development of the EU, its enlargement and
the stability of national systems.

3.6.
The consumption of medical products and services will
gradually increase placing an ever-greater financial burden on
aggregate costs.

3.7.3.
This method of assessment for healthcare provision
would be compatible with the principle of solidarity and
would demand a greater degree of direct responsibility of
professionals and patients.

This is why future healthcare reforms must focus on preven-
tion, promoting good health and developing community
medicine.

In view of these complex and costly organisational
3.6.1.
and economic problems, efforts must focus on a more rational
use of resources and on new approaches to healthcare.
Multifunctional and coordinated local services must be pro-
moted in all regions. A culture of coordination between
healthcare players and operators is essential. Home care
(nursing care, geriatrics, home hospitals) should also be one of
the priorities.

3.6.2.
Traditional hospital structures must be reformed. A
graded spectrum of services should be promoted, ranging from
general hospitals to more specialised care. To this end, inter-
regional and cross-border cooperation are essential. Pilot
schemes are already underway and should be encouraged.

Lastly, skills and professions are another aspect in
3.6.3.
the development of healthcare systems. A rationalisation
of medical disciplines and an assessment of paramedical
professions must take place before new medical specialities
can be recognised.

3.7.4.
Concerning lower priority forms of care which are
not matters for public health policy, there has been a rise in
supplementary insurance schemes (1).

3.8. We believe that the European Economic and Social
Committee should recommend establishing a method of
observation, analysis and exchange on national health policies
in view of the multitude of challenges that healthcare systems
face. This approach fully respects the fundamental principles
laid down in the Treaties,
in particular the principles of
subsidiarity and national competence. This would supplement
the initiative recently unveiled by the European Commission.

Benchmarking could be a valid approach to improving
3.9.
the quality of healthcare. The majority of reforms carried out
within the EU reveal the concern of public authorities and
managers to boost efficiency in hospitals and to set up
procedures to accredit and certify the quality of care.

3.9.1.
isational differences in national healthcare systems.

This approach transcends the conceptual and organ-

3.7.
Concerning the problem of the financial viability of
healthcare systems, it should be noted that there continue to
be significant differences in the design, quantity and quality of
systems.

3.9.2.
The use of Community tools for labelling, measures
to improve quality and the promotion of innovative tech-
nology and treatments on the basis of medico-economic
criteria could be encouraged.

3.7.1.
Framing and applying the concept of a guaranteed
core of medical goods and care is gradually becoming a reality
in the policies of EU Member States.

3.7.2.
As a result, a European approach could be promoted
to identify the services, healthcare products and standard
treatments linked to the main known illnesses with a view to
forming assessments and mutual recognition. This would be a
way of prioritising public funding and making healthcare
systems more effective.

3.9.3.
Equally, the Union must be able to ensure its citizens
have access to centres of health and hospital excellence, which
are not simply the privilege of the richer nations.

(1) See EESC Opinion on supplementary health insurance, OJ C 204

of 18.7.2000.

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4. Political responsibilities

4.1.
Although the organisation and funding of healthcare
systems are a matter for the domestic policies of Member
States, three issues are apparent at EU level:

5.1.5.
Establishing a European health insurance card to
ensure free movement and promote awareness of established
rights, aimed in particular at disadvantaged persons and the
elderly (1).

In this case, the Open Method of Coordination is not

5.2.
yet provided for in the field of healthcare.

4.2.
Article 152 of the EC Treaty on public health ensures
a high level of public health protection. However, despite the
fact that this Article concerns public health and in particular
all questions of prevention, it is weak in policy terms.

5.2.1.
could have the following objectives:

It must be put in place as a matter of urgency, and

Although the internal market rules oblige national
4.3.
policies to respect internal rules, there are restrictions, often
justified, in those Member States that have not yet recognised
the free movement of people, goods and services in this
domain.

— to modernise national systems by developing a quality

healthcare programme;

— to improve cooperation between Member States.

4.4.
The viability of public finances and the impact of
healthcare expenditure on national public spending are
covered in the stability and convergence pact.

Cooperation must enable common objectives to be identified,
if possible for healthcare and care for the elderly. These
objectives could then form part of national action plans, and
regular updates could be produced.

5. EESC proposals

5.1. With due regard for the respective competences of the
Member States and of
the problems raised and
the EU,
the contributions made by numerous players, the European
Economic and Social Committee proposes a series of measures
which are the result of using the Open Method of Coordi-
nation, detailing the objectives and principles in an approach
to healthcare and long-term care for the elderly:

Ongoing exchange of information and keeping tables
5.1.1.
of the activities, objectives and principles of all the EU Member
States.

5.1.2.
A strong and sustained employment policy: medical
professionals are unevenly distributed, therefore initiatives
must be taken at local and national level to boost supply
without waiting for demand. In particular there is an urgent
need to complete the final draft of the directive on the mutual
recognition of diplomas and skills.

General promotion of healthcare quality indicators:
5.1.3.
good practices in techniques, staff certification and accredita-
tion of facilities.

5.2.2.
In this context, relevant indicators should be selected
to assess policies. The challenges posed in 2001 — accessi-
bility, quality and financial viability — must take into account
demographic forecasts, the increase in the number of the
elderly and the progressive reduction in working time.

5.2.3.
If the Open Method of Coordination is well organ-
ised, it should respond to the impact of Community legislation
on national health insurance systems, and in particular take
into account new advances in case-law which may be handed
down by the European Court of Justice on a day-to-day basis
with regard to pending cases.

5.2.4.
provide answers to the following questions:

The Open Method of Coordination will have to

a) How to proceed in this process in the field of health

insurance?

b)

Is it feasible to set up an exchange of good practices
in accreditations, evaluations or prescriptions, defining
quality standards, defining the conditions for truly equiva-
lent skills and mutual recognition of practices?

Support for a general

information and communi-
5.1.4.
cation policy on existing systems, available facilities and the
policies currently pursued.

(1) See the Commission Communication concerning the introduction
of a European health insurance card — COM(2003) 73 final.

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c)

Concerning cost reduction, what benefits could be reaped
from exchanging good practices, given the diversity of
national systems?

Committee considers it essential to set up a simple, flexible,
efficient structure responsible for a series of priority actions as
set out in this opinion.

d) What progress has been made on identifying a quality

indicator for structures and practices?

e)

f)

How can policies governing the provision of healthcare
products be improved, giving greater emphasis to the
need for innovation, preventing wastage and the need to
give developing countries access to vital products to
combat diseases such as AIDS (see future WTO dis-
cussions and implementation of the Doha Agreements)?

Coordination of national provisions governing cross-
border trade in medicinal products must not lead to a
reduction in standards of distribution and advice in the
individual Member States.

In order to establish this Open Method of Coordination, to
make it visible and credible and to give it a solid basis, the

Brussels, 16 July 2003.

6. Conclusion

The European Economic and Social Committee intends to
make healthcare issues an area for action, whilst respecting
the existing Community political and legal framework. The
Committee feels there is a need to develop tools at European
level which draw on the collective European intelligence
beyond discussions on the future of national social security
systems. The Committee perceives a need for political will to
promote awareness of the realities of healthcare and to foster
excellence in innovative practice in the medical and social
domain. This is why it proposes creating effective bodies to
guarantee EU citizens the fundamental right of access to better
health for all.

The President

of the European Economic and Social Committee

Roger BRIESCH