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UK government says EU directive on services excludes health care

BMJ 2006; 332 doi: (Published 23 February 2006) Cite this as: BMJ 2006;332:444
  1. Rory Watson
  1. Brussels

    The extent to which private healthcare providers in one European Union country will be able to offer their services in another is now mired in confusion, after a vote in favour of liberalisation of services in the European parliament. An amendment said that healthcare services were excluded from the liberalisation.

    The uncertainty emerged after a large majority of members of the European parliament (MEPs) last week backed wide ranging moves to open up the services market across the EU. The parliament then seems to have approved a number of contradictory statements.

    Firstly, an amendment approved by the parliament made it clear that the liberalisation initiative did not undermine the ability of national authorities to determine their own public healthcare systems. Article 1 notes: “This Directive does not affect public health services and the access to public funding by health care providers.” This stance reflects the views of most EU governments.

    But the explanation to the amendment tabled by the parliament's Christian Democrats and the British Conservatives states that privately funded and private healthcare organisations should be covered by the legislation. This would open the door for companies to provide clinics, nursing homes, and other medical establishments beyond their own borders.

    Confusion set in when MEPs, in a subsequent vote, approved an amendment to Article 2, which seemed to rein in the move to liberalisation in health care. This stipulated that the directive would not apply to “healthcare, whether or not it is provided via healthcare facilities, and regardless of the ways in which it is organised and financed at national level or whether it is public or private.”

    The European Commission admits that the situation is “ambiguous.” The UK government, which would have liked to see more foreign competition in private health care, reluctantly believes that health as a whole is now outside the directive's remit.

    Christian Democrat MEPs are preparing to challenge the outcome, arguing that the second amendment should have fallen after the first had been passed. The outcome of the vote has prompted mixed reactions.

    The Standing Committee of European Doctors (a representative body of doctors' organisations in the EU) and the European Public Health Alliance (a network of European non-governmental organisations working on public health), among others, want the health sector to be totally exempted. They argue that if there are to be EU regulations concerning health, these should be part of health specific legislation and not part of broader measures for all services.

    Europe's consumer organisations are campaigning to include public and private health in the liberalisation of services, as this would make it easier for patients to select the most appropriate treatment either at home or abroad. The European Commission is now considering separate legislation on patients crossing borders for health care—a right recognised by the European Court of Justice.

    Now that the European parliament has given its first opinion on the draft legislation, the European Commission has to decide which amendments to accept. The likelihood is that it will retain almost all. The text will then pass to EU governments to decide on their own changes.

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