G/1 - Michael Hübel A Europe of Patients? EU Health Systems in a Changing Environment The Political Dimension: Development and Interaction of Health Systems in Europe - EU Initiatives Michael Hübel, European Commission Bad Hofgastein, 26 September 2002

G/1 - Michael Hübel Community policies have an impact on health and health systems Internal Market - Products (pharmaceuticals, medical devices, food,...)Internal Market - Products (pharmaceuticals, medical devices, food,...) Free movement of health professionals, citizens seeking health care, and health servicesFree movement of health professionals, citizens seeking health care, and health services environmental policy – rules on water, air, quality, emissionsenvironmental policy – rules on water, air, quality, emissions social policy – social protection, health and safety at worksocial policy – social protection, health and safety at work research – life sciences programme; telematics – information society, eEuroperesearch – life sciences programme; telematics – information society, eEurope preparing for enlargementpreparing for enlargement

G/1 - Michael Hübel Health in the EU Competence of the Community defined by Member States (Treaty)Competence of the Community defined by Member States (Treaty) Public Health: Relatively recent (1993)Public Health: Relatively recent (1993) Relatively controversial (prerogatives of the Member States - Subsidiarity)Relatively controversial (prerogatives of the Member States - Subsidiarity) Relatively low-keyRelatively low-key

G/1 - Michael Hübel Public Health in the European Union But only since 1993 a specific Treaty Article (129 - Maastricht) on public healthBut only since 1993 a specific Treaty Article (129 - Maastricht) on public health 1993: Framework for action in the field of public health - Eight public health action (= funding) programmes1993: Framework for action in the field of public health - Eight public health action (= funding) programmes

G/1 - Michael Hübel 1999/2000: A new Role for Health in the Community New Treaty provisionsNew Treaty provisions New Commission - Health and Consumer Protection portfolioNew Commission - Health and Consumer Protection portfolio New challenges to health systemsNew challenges to health systems EnlargementEnlargement

G/1 - Michael Hübel 2001/2002: A changing political environment ECJ Cases: Kohll/Decker etcECJ Cases: Kohll/Decker etc Internal market and health: High Level Committee on Health reportInternal market and health: High Level Committee on Health report Increased movement of patientsIncreased movement of patients

G/1 - Michael Hübel Response at EU level European Council: Future of Health Care and Care for the ElderlyEuropean Council: Future of Health Care and Care for the Elderly Health Council: Mobility of patients (Malaga informal meeting)Health Council: Mobility of patients (Malaga informal meeting) Public health: New programmePublic health: New programme

G/1 - Michael Hübel Health care and care for the elderly (1) Gothenburg European Council asks for reportGothenburg European Council asks for report Commission Communication December 2001: focus on quality, access and financial viabilityCommission Communication December 2001: focus on quality, access and financial viability Report to Barcelona European CouncilReport to Barcelona European Council Barcelona Conclusions: Continue work on the three priority areas, prepare report for European Council (Greek Presidency)Barcelona Conclusions: Continue work on the three priority areas, prepare report for European Council (Greek Presidency)

G/1 - Michael Hübel Health care and care for the elderly (2) Questionnaire to Member StatesQuestionnaire to Member States Commission communication (End 2002)Commission communication (End 2002) Report to Athens CouncilReport to Athens Council Context: ‘Lisbon’ process - Open co-ordination?Context: ‘Lisbon’ process - Open co-ordination? Main Actor: Social Protection CommitteeMain Actor: Social Protection Committee

G/1 - Michael Hübel Circulation of patients (1) Malaga Meeting of Health Ministers Increasing movement of patientsIncreasing movement of patients Added value: Reference centres, sharing unused capacity, border regions, long-term residentsAdded value: Reference centres, sharing unused capacity, border regions, long-term residents Information on quality and cost of health careInformation on quality and cost of health care

G/1 - Michael Hübel Circulation of patients (2) Menorca meeting of experts - Gathering experience in four priority areasMenorca meeting of experts - Gathering experience in four priority areas Council conclusions June 2002:Council conclusions June 2002: –Welcomes the debate launched in Malaga –Supports launch of a high level reflection group –Work in this field to be undertaken by the Public health programme

G/1 - Michael Hübel Circulation of patients (3) Launch of a reflection process with Health Ministers and key stakeholders - AutumnLaunch of a reflection process with Health Ministers and key stakeholders - Autumn Report: second half of 2003Report: second half of 2003

G/1 - Michael Hübel New Public Health Programme (1)  Adopted Summer 2002  Runs from 1st January 2003 until 31 December 2008  Budget fixed at € 312M (budget to be reviewed)

G/1 - Michael Hübel New Public Health Programme (2) 3 Strands of action 1 -Health Information 2 - Rapid Reaction 3 - Health Determinants

G/1 - Michael Hübel New Public Health Programme (3) Funding priorities to be agreed with programme committeeFunding priorities to be agreed with programme committee Possible relevant actionsPossible relevant actions: –Map patient mobility and cross-border co-operation agreements –Bring together information on centres of excellence –Collect information related to quality of services –Support the high-level process

G/1 - Michael Hübel Outputs of the programme  Pilot Projects  Databases, indicators  Information systems  Analyses and reports  Networks and better co-ordination  Stakeholder community  Guidelines and Recommendations  Legislative instruments  Long-term structures

G/1 - Michael Hübel Develop the Community’s health strategy Ensure coherence and complementarityEnsure coherence and complementarity Understand Member States’ and stakeholders needs and requirementsUnderstand Member States’ and stakeholders needs and requirements Define the scope of the Community’s roleDefine the scope of the Community’s role

G/1 - Michael Hübel Final points Member States are facing common challenges to their health systemsMember States are facing common challenges to their health systems Many EU policies and actions haven an impact on health and health systemsMany EU policies and actions haven an impact on health and health systems Health is moving upwards on the Community agenda and being dealt with in different for aHealth is moving upwards on the Community agenda and being dealt with in different for a There is uncertainty about the exact outcome, but cleaarly a need for coherence and complementarityThere is uncertainty about the exact outcome, but cleaarly a need for coherence and complementarity But health will remain an area with many players: public/private, EU/Member States, WHO, providers, patientsBut health will remain an area with many players: public/private, EU/Member States, WHO, providers, patients

G/1 - Michael Hübel Further information on Public Health Policy: