Free movement of persons

Initially limited to workers, the principle of free movement was expanded to all persons with the Treaty of Amsterdam (1997).

Patient mobility

A coordination mechanism for social protection benefits was set up in the early 1970s to facilitate the mobility of workers. Its healthcare component evolved quite significantly. There are now two systems for healthcare coverage in the cross-border context: one from the Community law regime based on Regulation 883/2004, and one from a jurisprudence-based regime that initially drew on Articles 28 and 30 EC (free movement of goods) and articles 49 and 50 EC (free provision of services). This second regime especially covers measures such as requiring prior authorisation to get non-urgent ambulatory care abroad, unless this is dictated by reasons of public order, such as public health protection, or imperative requirements in the general interest.

The legal uncertainty that came from this jurisprudence led Member States to focus on concerted efforts and closer collaboration in this area at the European level.

In 2002, the European Commission opened a high-level process of reflection on patient mobility and the impact of the internal market on national healthcare systems. In December 2003, the final report of the process of reflection was presented. It contained 19 recommendations for EU-level action.

On 20 April 2004, the European Commission presented its response to the recommendations of the process in the form of a communication on patient mobility.

The Commission proposed European co-operation in four areas:

• patient safety;
• mobility of health professionals;
• European centres of reference;
• health technology assessment.
  

To steer this co-operation process, the Commission created a High Level Group on health services and medical care. The group is composed of representatives from the Member States, the Commission, and European associations. HOPE was invited also to join the process.

Then following a consultation that ended in January 2007, the Commission has presented a draft directive on patient rights in cross-border care on 2 July 2008. A revised version of the draft directive was adopted by the European Parliament in April 2008 in first reading. It is still debated in the Council.

Then following a consultation that ended in January 2007, the Commission has presented a draft directive on patient rights in cross-border care on 2 July 2008. A revised version of the draft directive was adopted by the European Parliament in April 2009 in first reading. It was then debated in the Council and a compromise was reached before the adoption in second reading of the European Parliament in January 2011. The Council should make a final decision in February 2011.

Free movement of professionals

Both salaried and self-employed hospital and healthcare professionals are covered by general community provisions applicable to all workers, but also by more specific provisions for the healthcare sector.

Article 39 of the EEC Treaty states that “freedom of movement for workers shall be secured within the Community”. It was a principle that should allow workers to seek employment throughout the Community. For self-employed persons, the right of establishment was defined in article 43. A Member State always has the possibility of establishing provisions for access to or the right to exercise a specific activity, but such provisions must meet four requirements: applied without discrimination, justified on imperative requirements in the general interest, suitable for securing the attainment of the objective that they pursue and, finally, must not go beyond what is necessary in order to achieve the defined objective.

Five of the seven professions that were the object of so-called “sectoral” directives are in the health sector: doctors, nurses, midwives, dentists and pharmacists. Those directives were amended by Directive 2005/36/CE on the recognition of professional qualifications. Other professions found in the hospital are covered by the general system for the recognition of professional qualifications. In both cases, the directives harmonise minimum training conditions and provide for the automatic recognition of professional qualifications.

Moreover, to ensure that disparities in training and professional qualifications do not constitute a barrier to the free movement of workers, a series of provisions were adopted for the protection of workers, all within the rationale of the internal market.
The free movement principle is the legal basis for community intervention regarding the safety and health of workers, in order to allow free movement of workers while guaranteeing them a “high level of health protection”. In 1974, a resolution on a social action programme with a strand devoted to occupational health and safety was adopted for the first time. The Single European Act (1987) conferred the Community with real powers over occupational health and safety, allowing it to adopt measures through qualified majority voting. Since then, a series of specific provisions have been adopted in this context. Some are specific to certain categories of hospital workers.

Activities

Hospitals in the 27
EU Member States

Quality of care

Human resources

Public health

Hospital, health care
and internal market
Free movement of goods
Free movement of persons
Free movement of services

e-Health

Cross-border
co-operation

Green hospitals

Networking