Draft health directive: reinforced 2-speed medicine?

(B2 archives) The health services directive is drafted by the services of European Commissioner Markos Kyprianou (photo). A first draft has just been presented - in interdepartmental consultation (all the Commission departments concerned must give their opinion). Project of which I was informed and detailed in Europolitique.

The content of this text is complex. At the same time, it seems to give rights to patients but, at the same time, it does not place all patients on the same level of equality. At the same time, it seems to want to apply the case law of the Court but, at the same time, it does not apply all the elements, contenting itself with picking some. In fact, it abandons the principle of solidarity which thus guides social security systems is forgotten in favor of a new, more individualistic logic.

Let us point out some hiatuses, contradictions and problems of this project:

This text thus establishes a new method of reimbursement for patients who intend to travel abroad to receive treatment there. But it does not provide for prior care (unlike the current situation). Concretely, only patients who can advance care (in hospital matters, this represents several tens of thousands of euros), will be able to benefit from this directive. To go quickly, the rich or the best trained (those close to the medical community).

It leaves a whole set of elements unclear: what about liability in the event of damage, follow-up care on return to the country, reasonable time to remain on a waiting list, etc.

It does not solve the most important problems currently facing the health sector: the growing shortage of jobs in many sectors, the compensation between the countries which train doctors and those which receive them, and above all the interpretation of competition and internal market rules (dominant position, agreement, freedom to provide services, etc.) in the face of the specific situations of health services (hospital card, need for approval, establishment of clinical or hospital services, etc.).

Finally, while its objective is "quality of care", it does not establish a universal obligation of care services for all European residents (while this type of obligation has already been established in a number of directives: banks , posts, transport).

While the system of "two-speed medicine" already exists in practice, this text does nothing to mitigate the differences, on the contrary reinforces and accelerates them, by striking a blow in the health services from which the most benefit large number. The legal basis chosen to act "the internal market" is moreover symptomatic of the "liberal" vision which governs this project (the bases "public service", "social security", "public health" have thus been left aside because too binding).

Being a bit caustic, the provisions of the first draft Bolkestein directive, on "services", were more "balanced" and "reasonable" than this draft!