1. The Free Movement of Health Professionals Fórum Mercosul Rio de Janeiro, March 22th 2006 Johann Wolfgang Goethe-University, Frankfurt Institute of Medical Sociology Thomas Gerlinger

2. 2 Contents 1.The European Union and the Health Care Sector 2.Legal Provisions on the Free mMovement of Health Professionals 3.Extent of Transnational Migration of Health Professionals 4.The Draft Services Directive 5.Conclusions

3. 3 The European Union 25 member states 460 million people common market: free movement of goods capital Persons services predominance of economic integration lack of corresponding political competencies at the European level (esp. social policy)

4. 4 EU‘s Main Obligations in Health Policy direct attention to improving the health of the population ensure a high level of health protection in all fields of Community policy

5. 5 EU‘s Main Competencies in Health Policy subsidiary role promote cooperation complement national policies explicit regulatory authority health and safety at work consumer protection

6. 6 Nation-States‘ Main Competencies in Health Policy type and extent of coverage in case of illness organization of services institutional structures division of labour mode of regulation of the health care system

7. 7 Legal Provisions on Recognition of Certificates (1/3) sectoral directives educational requirements provisions for admission duration of training scope of training minimum standards

8. 8 Legal Provisions on Recognition of Certificates (2/3) general directives assumption: uniformity of qualifications in the member states no harmonization of qualifications

9. 9 Physicians Directive (3/3) automatic recognition citizenship of a member state diploma is aquired in one of the member states training in one of 52 listed specializations

10. 10 Transnational Migration of Health Professionals (1/2) differences in income level differences in workung conditions working hours work load Dissatisfaction among health professionals

11. 11 Transnational Migration of Health Professionals (2/2) increase of migration but no massive migration („brain drain“) mostly from poorer to richer countries

12. 12 Barriers language problems restricted admission by some member states

13. 13 German Example (2003) 340 000 doctors 11 800 from abroad (4 %) 5 200 from EU countries (1,8 %) 2 500 from newly admitted east European member states (0,8 %) 1 300 office-base (self-employed) doctors (1,0 % of office-based doctors) Nurses: 7,7 % from abroad

14. 14 EU‘s Competencies in Health Policy subsidiary role promote cooperation complement national policies explicit regulatory authority health and safety at work consumer protection

15. 15 Draft Services Directive prohibition of arbitrary requirements for establishing services delivering services from abroad within the EU country of origin pinciple

16. 16 Draft Services Directive – Effects loss of control by the target country loss of quality in care social dumping working conditions salaries

17. 17 Conclusions free movement of health profssionals system of mutual recognition of certificates increase of transnational migration rut remaining low in quantity divergent interests of employees in the European Union binding regulations of social standards needed better cooperation on European level