Opinion of the Committee of the Regions on the  Communication from the Commission to the Council, the European Parliament, the European Economic and Social Committee and the Committee of the Regions: Modernising social protection for the development of high-quality, accessible and sustainable health care and long-term care: support for the national strategies using the ‘open method of coordination’
Date: 2004-09-30
Institutions: European Committee of the Regions
Subjects: competence of the Member States, health care system, health policy, right to health, social security

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Official Journal of the European Union

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2.42
emphasises the need to ensure when the Directive is
implemented that professional bodies can perform their present
duties without restrictions in future,
too. The existence of
if
compulsory membership schemes currently means
service providers intend to set up in business in another
Member State, they must contact the competent professional
bodies in that country directly. It is therefore important,
in
connection with the establishment and setting-up of single
points of contact, to take account of current responsibilities
and allocations of tasks;

that

2.43
is also aware of the new challenges and tasks facing
professional bodies, especially as possible single points of

contacts or in connection with the drafting of new codes of
conduct at Community level;

2.44
for this purpose asks Member States, regional and
local authorities and all other interested parties to prepare
themselves in good time for the challenges set by the new
Directive;

2.45 would urge that actions should not be guided by
defensive reflexes but that the chances presenting themselves to
each Member State's service providers and citizens and to the
internal market as a whole should be seized.

Brussels, 30 September 2004

The President

of the Committee of the Regions

Peter STRAUB

Opinion of the Committee of the Regions on the Communication from the Commission: Follow-
up to the high-level reflection process on patient mobility and health-care developments in the
European Union and the Communication from the Commission to the Council, the European
Parliament, the European Economic and Social Committee and the Committee of the Regions:
Modernising social protection for the development of high-quality, accessible and sustainable
health care and long-term care: support for the national strategies using the ‘open method of coor-
dination’

(2005/C 43/07)

THE COMMITTEE OF THE REGIONS

Having regard to the Communication from the Commission: Follow-up to the high-level reflection process on
patient mobility and health-care developments in the European Union and the Communication from the Commission
to the Council, the European Parliament, the European Economic and Social Committee and the Committee of the
Regions: Modernising social protection for the development of high-quality, accessible and sustainable health care and
long-term care: support for the national strategies using the ‘open method of coordination’ (COM(2004) 301 final
and COM(2004) 304 final),

Having regard to the European Commission's decision of 20 April 2004, under Article 265(1) of the
Treaty establishing the European Community, to consult the Committee on the subject,

Having regard to the CoR president's decision of 5 April 2004 to instruct the Commission for Economic
and Social Policy to draw up an opinion on the subject,

Having regard to the Communication from the Commission to the Council,
the
Economic and Social Committee and the Committee of the Regions on the health strategy of the European Community
and the Commission's Proposal
the Council adopting a
programme of Community action in the field of public health (2001-2006) (COM (2000) 285 final),

for a Decision of the European Parliament and of

the European Parliament,

Having regard to the Communication from the Commission to the Council,
the
Economic and Social Committee and the Committee of the Regions: Strengthening the social dimension of the Lisbon
strategy: Streamlining open coordination in the field of social protection (COM(2003) 261 final),

the European Parliament,

Having regard to the Communication from the Commission to the Council,
the
Economic and Social Committee and the Committee of the Regions: The future of health care and care for the elderly:
guaranteeing accessibility, quality and financial viability (COM(2001) 723 final),

the European Parliament,

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C 43/23

Having regard to the Commission's Proposal for a Directive of the European Parliament and of the Council on
services in the internal market (COM(2004) 2 final),

Having regard to the report submitted on 9 December 2003 entitled High-level process of reflection on
patient mobility and health-care developments in the European Union,

Having regard to its draft opinion (CdR 153/2004 rev. 1) adopted on 6 July 2004 by the Commission for
Economic and Social Policy (rapporteur: Ms Bente Nielsen, Member of Århus County Council (DK, PES);

ADOPTED THE FOLLOWING OPINION

unanimously at its 56th plenary session on 29 and 30 September 2004 (session of 30 September).

1. The Committee of
recommendations

the Regions' overall views and

THE COMMITTEE OF THE REGIONS

considers that, between them, the Commission's two
1.1
communications on Follow-up to the high-level reflection process on
patient mobility and health-care developments in the European Union
and Modernising social protection for
the development of high-
quality, accessible and sustainable health care and long-term care:
support for the national strategies using the ‘open method of coordi-
nation’ constitute a framework that presents an overall strategy
for developing a shared vision for the European health-care and
social protection systems. The two communications should
therefore be considered together and the Committee of the
Regions calls for the parallel coordination of the further work
on the initiatives and processes proposed therein;

representatives should sit on the High-level Group on Health
Services and Medical Care which will assist the Commission in a
range of key areas, including developing the rights and duties
of patients; sharing spare capacity between the various health-
care systems and cross-border cooperation;
identifying Euro-
pean centres of reference; and coordinating assessment of new
health technologies. The Committee of the Regions therefore
calls on the Commission to ensure that regional and local
authorities are represented on this group;

1.5
feels that particular attention must be paid to the new
Member States in order to meet shared and prospective health-
care challenges. Clear priority should be given to supporting
the new Member States in developing health measures and
improving people's state of health, so as to reduce the discre-
pancies and imbalances that exist on the health front within
the Union, in order, gradually, to come within range of the top
EU benchmark.

1.2
stresses that a joint European strategy for establishing a
shared vision of European health and social security systems
must not lead to any extension of the EU's healthcare remit. A
shared European vision for health and social security systems
must not result
in any moves towards harmonisation or
opaque regulatory initiatives. Health care – and its organisation
and funding – is the concern and responsibility of the Member
States and that must be respected. It is essential to comply with
the subsidiarity principle;

Patient mobility and health-care developments in the European
Union (COM(2004) 301 final)

2. The Committee of the Regions' views and recommen-

dations

notes that,

in some Member States, it is the regional
1.3
and local authorities that are responsible for health and the
health-care sector. The Committee of the Regions, and the
regions responsible in these areas, would like therefore to be
involved in and contribute to establishing a common European
health strategy and must be secured influence over
the
Community's global health strategy in relation to decisions and
initiatives that touch on the remit and responsibilities of local
and regional authorities in the health and health-care sectors;

1.4
trusts that the regional and local authorities will be
involved in implementing the initiatives to establish a shared,
global European health strategy, for instance in the develop-
ment of health indicators and benchmarking. The Committee
of the Regions therefore feels that regional and local authority

THE COMMITTEE OF THE REGIONS

2.1
is pleased that the Commission recognises that, to meet
the requirement that a high level of human health protection
be ensured in the definition of all Community policies and
activities (Treaty Article 152(1)), it is necessary to increase the
involvement of the political authorities responsible for health,
health systems and health care. It is vital to ensure that the
impact of Community initiatives should be included in the
overall impact assessment of new policies and that an assess-
ment of this kind should also consider the interplay between
Community rules and the implications for Member States'
health systems and national health policy objectives. Given that
health, health systems and health care in many Member States
are the responsibility of the local and regional authorities, the
Committee of the Regions recommends that the regional and
local level should be involved;

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2.2
considers – following on from that – that it is vitally
important to clarify the impact on citizens' rights under Com-
munity law to seek health care in other Member States and to
be reimbursed for such care received in another Member State
as set out in the Proposal for a Directive on services in the
internal market, and in Regulation 1408/71 on the coordina-
tion of social security schemes;

2.3
asks that, when comparing health care and service
provision as set out in the proposed services directive, the
Commission should make sure that health care does not
become solely a marketing commodity driven by the prospect
of economic gain but,
is also underpinned by
in contrast,
criteria geared to considering an individual's health, course of
treatment and quality of life;

recommends that,

2.4
in its work to disseminate and
improve information on citizens' rights under Community law,
the Commission should uphold the right of individual Member
States to lay down rules for rights and obligations pertaining to
the health-care system under their own social security schemes
and the various conditions that apply to different services
under Member States' health-insurance systems;

2.5
also considers that it is not only a question of securing
citizens' rights under Community law and providing public
information on the subject. More consideration should be given
to the possibilities of ensuring provision of a responsive and
accessible system that enables all patient groups to make use of
the available rights and options. This will ensure that more
vulnerable patient groups such as older people with no social
network and the mentally ill are in a position to draw on their
rights under Community law. For that to happen, it is essential,
for instance, that information should be available wherever the
public demands it and that
such information should be
followed up by competent advice and guidance in the indivi-
dual Member States;

2.6
asks that, in the development of initiatives designed to
secure the cross-border sharing of spare capacity and health
care – as well as in European rules on the recognition of
professional qualifications and in the ongoing simplification
process – care should be taken in this regard to ensure that the
initiatives do not have an adverse impact on the appropriate
distribution of medical and health-care staff between the
Member States to the detriment,
the new
Member States;

for instance, of

is pleased that the Commission recognises the impor-
2.7
tance of a structured overall health technology assessment that
can provide a solid basis for the evaluation and documentation
of health-related devices, products and techniques;

2.8
feels in this regard that structured and coordinated
European-level cooperation with a view to exchanging experi-
ence, sharing knowledge and simplifying arrangements relating
to developments in health technology may bring clear value
added to the Member States;

considers that access to high standards of sound data
2.9
and information is crucial to any moves Member States might
make to determine best practice and compare standards, and is
thus also a sine qua non for implementing many of
the
proposed initiatives. The requisite frameworks for a systematic
European data and information system should, as the Commis-
sion points out, be established in cooperation with other
players in the field and should be coordinated with the ongoing
OECD and WHO initiatives and work in this area. It is up to
the individual Member States to implement measures and carry
through new schemes in the light of the comparable data and
information;

regional and local authorities

thinks that the Commission should do more to ensure
2.10
that
responsible for health
systems and health care are involved and take part in coopera-
tion on health services and medical care and in the group set
up on this issue.

Modernising social protection for the development of high-
quality, accessible and sustainable health care and long-term
care: support for the national strategies using the ‘open method
of coordination’ (COM(2004) 304 final)

3. The Committee of the Regions' views and recommen-

dations

THE COMMITTEE OF THE REGIONS

3.1 welcomes the Commission's global aim in this commu-
nication, namely to define a common framework to support
Member States in the reform and development of health care
and long-term care, borne by the social protection system,
using the ‘open method of coordination’;

can support the three general objectives: accessibility of
3.2
care for all, based on fairness and solidarity, provision of high-
quality health care and assurance of the long-term financial
sustainability of such care;

3.3
finds that establishing an overall common framework
and securing the general objectives can help meet future chal-
lenges such as demographic ageing, persistent problems of
accessibility as characterised by unequal access to health care
and services,
imbalances between the provision of quality
services and public needs, and financial imbalances in certain
systems;

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3.4
stresses that the process for drawing up indicators and
benchmarking criteria should be carried out showing full
respect for Member States' responsibilities for providing and
organising health care and take account of the various and
divergent conditions in the individual Member States.
is
extremely important for these indicators to be based as far as
possible on already accessible data. There is a risk that an
excessive number of indicators could create unacceptable levels
of extra work at the local and regional levels;

It

stresses,

in this connection,

3.5
that health care and
services in many Member States are managed by the regional
and local authorities, which, moreover, often have major
responsibilities in the fields of health education and preventive
health care and of home care services, which serve to avert or
reduce the need for recourse to residential care facilities. Thus,
local and regional authorities, as essential actors and in accord-
ance with the principles of the open method of coordination,
should be involved in the drawing-up of national action plans
and the establishment of indicators and benchmarking criteria;

3.6
urges that some of the indicators drawn up should
relate to quality, as it is difficult for strictly quantitative indica-
tors to cover so-called ‘feminine’ values, such as care for the
elderly and the provision of a high quality of life. The quality
of health care should therefore not be seen simply in cost-
benefit terms but also in terms of the range of different services
it offers;

3.7 wishes, furthermore, to point out that the establishment
of these indicators and the implementation of benchmarking
criteria in accordance with use of the open method of coordi-

Brussels, 30 September 2004.

nation should also take account of
departure of the various Member States;

the different points of

calls upon the Commission to support the development
3.8
of a network for exchanging experiences and spreading best
practice, which is an important part of the open method of
coordination;

3.9 welcomes the focus on the significance of other poli-
cies for health and health care and considers that closer coordi-
nation with other political processes, such as the employment
strategy, will be important to achieving the general objectives.
The CoR is therefore pleased at the focus on the need for
investments in basic and further training for health-care profes-
sionals based on the principle of lifelong learning and the
formulation of policies on health and safety at the workplace
and the creation of higher-quality jobs. In time this can help
keep staff in the health-care sector and, hopefully, facilitate
recruitment, which is essential to meeting the common chal-
lenges of demographic ageing and shortage of labour;

3.10
considers that an increased focus on marginalised
groups, such as elderly people outside the safety net, ethnic
minorities and low income groups, is of prime importance to
achieving the general objective of fair access for all to health
care. In this connection steps should be taken, as back-up for
the Member States' own efforts to change things, to develop
support machinery for these marginalised groups so that health
inequalities can be reduced. The development of such support
machinery requires the involvement and mobilisation of all the
relevant players.

The President

of the Committee of the Regions

Peter STRAUB