1. Directive on Services in the Internal Market Issues related to health services

2. Background and Scope Covers both the right of establishment and the right to free movement of services Covers all economic services that are not already covered by Internal Market legislation and specifically exempt Financial services Electronic communication services (2002 regulatory package) Transport services Services of general economic interest

3. Health services and the Internal Market it follows from settled case-law that Community law does not detract from the power of the Member States to organise their social security systems (…) Therefore, in the absence of harmonisation at Community level, it is for the legislation of each Member State to determine the conditions on which social security benefits are granted (…) However, it is nevertheless the case that the Member States must comply with Community law when exercising that power.” Muller- Faure C385/99 Paragraph 100

4. The Services Directive and Member States’ competence The directive is fully consistent with the case law. It does not: Detract from Member States’ competence to organise their health service and the way they finance it. Require deregulation or privatisation of health services. Provide for any harmonisation of health services. It only clarifies how the right of establishment and free movement of services applies to health services.

5. Patient mobility- Summary of the case law Defining restrictions (Kohll) Justifying restrictions - Prior authorisation schemes Hospital care (Smiths and Peerbooms) Non-hospital care (Müller-Faure) Level of assumption (Vanbraekel)

6. Article 23 on patient mobility Costs of non- hospital care must be reimbursed. Authorisations to receive hospital care must be granted when the care cannot be given within a medically justifiable timeframe. The level off assumption must be at least at the level provided in the patient’s Member State of affiliation. Clarification of the distinction between hospital and non-hospital care.

7. Establishment- Mutual evaluation Authorisation schemes must be: Justified by overriding reasons in the general interest, Proportionate and Non- discriminatory Prohibited requirements and requirements to be evaluated

8. Free provision of services The country of origin principle Applies to cross border provision of services, not establishment. Applies to all regulations falling within the coordinated field.

9. Exceptions relevant to health services 1.All issues regulated by the Directive on regulated professions, article 17 (8). 2.Justified prohibitions, article 17 (16). 3.Requirement linked to specific characteristics of the place where the service is provided, article 17 (17). 4.The authorisation system applicable to the reimbursement of hospital care, article 17 (18) 5.Consumer contracts, article 17 (21). 6.Case by case derogations, article 19.

10. Further information http://europa.eu.int/comm/internal_mar ket/services/services- dir/index_en.htm