Activities of Kartika Tamara LIOTARD related to 2008/0142(COD)
Plenary speeches (3)
Patients' rights in cross-border healthcare (debate)
Patients' rights in cross-border healthcare (A6-0233/2009, John Bowis)
Patients’ rights in cross-border healthcare (debate)
Amendments (47)
Amendment 43 #
Proposal for a directive
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The European Parliament rejects the Commission proposal.
Amendment 46 #
Proposal for a directive
Title
Title
PROPOSAL FOR A DIRECTIVE OF THE EUROPEAN PARLIAMENT AND OF THE COUNCIL on the application of patients' rights in cross-border healthcarecross-border patient mobility and patients' rights
Amendment 49 #
Proposal for a directive
Citation 1
Citation 1
Having regard to the Treaty establishing the European Community, and in particular Article 9542, 152 and 308 thereof,
Amendment 54 #
Proposal for a directive
Recital 1 a (new)
Recital 1 a (new)
(1a) Notwithstanding this directive, Member States themselves retain responsibility for providing safe, high- quality, efficient and quantitatively sufficient health care to the citizens within their territory. Member States must on no account dismantle health care because it is also available in other Member States. Moreover, this Directive must not have the result of encouraging patients in any way whatsoever to go to another Member State to obtain health care.
Amendment 56 #
Proposal for a directive
Recital 2
Recital 2
Amendment 57 #
Proposal for a directive
Recital 2
Recital 2
(2) Given that that the conditions for recourse to Article 95 of the Treaty as a legal basis are not fulfilled, the Community legislature shall rely on thise same legal basis even when public health protection is a decisive factor in the choices made; in this respectas Regulation 883/2004/EC on the coordination of social security systems, and should also take Article 95(3)152 of the Treaty explicitly requires that, in achieving harmonisation, ainto account. A high level of protection of human health should be guaranteed taking account in particular of any new development based on scientific facts.
Amendment 66 #
Proposal for a directive
Recital 6
Recital 6
Amendment 68 #
Proposal for a directive
Recital 8
Recital 8
(8) This directive aims to establish a general framework forcomplement Regulation 1408/71 and its successor Regulation 883/2004 with regard to the provision of safe, high quality and efficient cross-border healthcare in the Community and to ensure patients mobility and freedom to provide healthcarethe application of patients' rights in the framework of patients mobility and a high level of protection of health, whilst fully respecting the responsibilities of the Member States for the definition of social security benefits related to health and the organisation and delivery of healthcare and medical care and social security benefits in particular for sickness.
Amendment 79 #
Proposal for a directive
Recital 10
Recital 10
(10) For the purpose of this Directive, the concept of "cross-border healthcare" covers the following modes of supply of healthcare: - Uonly the use of healthcare abroad (i.e.: a patient moving of his/her own accord to a healthcare provider in another Member State for treatment); this is what is referred to as 'patient mobility'; - Cross-border provision of healthcare (i.e.: delivery of service from the territory of one Member State into the territory of another); such as telemedicine services, remote diagnosis and prescription, laboratory services; - Permanent presence of a healthcare provider (i.e.: establishment of a healthcare provider in another Member State); and, - Temporary presence of persons (i.e.: mobility of health professionals, for example moving temporarily to the Member State of the patient to provide services).
Amendment 80 #
Proposal for a directive
Recital 10
Recital 10
(10) For the purpose of this Directive, the concept of "cross-border healthcare" covers the following modes of supply of healthcare: - Use of healthcare abroad (i.e.: a patient moving to a healthcare provider in another Member State for treatment); this is what is referred to as 'patient mobility'; - Cross-border provision of healthcare (i.e.: delivery of service from the territory of one Member State into the territory of another); such as telemedicine services, remote diagnosis and prescription, laboratory services; - Permanent presence of a healthcare provider (i.e.: establishment of a healthcare provider in another Member State); and, - Temporary presence of persons (i.e.: mobility of health professionals, for example moving temporarily to the Member State of the patient to provide services).
Amendment 85 #
Proposal for a directive
Recital 10 a (new)
Recital 10 a (new)
(10a) Furthermore, for the purpose of this Directive, the concept of "cross-border healthcare" covers Emergency Medical Services, which handle the calls to the European emergency number 112 and treat victims of accidents and mass emergencies, especially in border areas.
Amendment 96 #
Council position
Recital 1 a (new)
Recital 1 a (new)
(1a) Notwithstanding this Directive, Member States themselves retain responsibility for providing safe, high- quality, efficient and quantitatively sufficient health care to citizens within their territory. On no account may Member States dismantle health care because it is also available in other Member States. Moreover, this Directive must not have the result of encouraging patients in any way whatsoever to go to another Member State to obtain health care.
Amendment 98 #
Council position
Recital 6
Recital 6
Amendment 100 #
Council position
Recital 8
Recital 8
(8) This Directive aims to establish rules for facilitatingcomplement Regulation (EC) No 883/2004 with regard to the access to safe and high- quality cross- border healthcare in the Union and to ensure patient mobility in accordance with the principles established by the Court of Justice and to promote cooperation on healthcare between Member Statesthe application of patients' rights in the context of patient mobility, whilst fully respecting the responsibilities of the Member States for the definition of social security benefits relating to health and for the organisation and delivery of healthcare and medical care and social security benefits, in particular for sickness.
Amendment 109 #
Proposal for a directive
Recital 19
Recital 19
Amendment 110 #
Proposal for a directive
Recital 21
Recital 21
Amendment 113 #
Council position
Recital 25
Recital 25
Amendment 114 #
Council position
Recital 27
Recital 27
Amendment 115 #
Proposal for a directive
Recital 22
Recital 22
Amendment 118 #
Council position
Recital 32
Recital 32
Amendment 118 #
Proposal for a directive
Recital 23
Recital 23
Amendment 123 #
Council position
Recital 44
Recital 44
(44) The Member States should decide on the form and number of their national contact points. Such national contact points may also be incorporated in, or build on, activities of existing information centres provided that it is clearly indicated that they are also national contact points for cross-border healthcare. The national contact points should have appropriate facilities to provide information on the main aspects of cross-border healthcare, including the potential risks involved. The Commission should work together with the Member States in order to facilitate cooperation regarding national contact points for cross-border healthcare, including making relevant information available at Union level. The existence of national contact points should not preclude Member States from establishing other linked contact points at regional or local level, reflecting the specific organisation of their healthcare system.
Amendment 129 #
Proposal for a directive
Recital 26
Recital 26
Amendment 132 #
Proposal for a directive
Recital 26
Recital 26
(26) This Directive does not provide either for transfer of social security entitlements between Member States or other coordination of social security schemes. The sole objective of the provisions regarding prior authorisation and reimbursement of healthcare provided in another Member State is to enable freedom to provide healthcare for both patients and healthcare providers and to remove unjustified obstacles to that fundamental freedom within the patient's Member State of affiliation. Consequently the Directive fully respects the differences of national health-care systems and the Member States' responsibilities for organisation and delivery of health services and medical care.
Amendment 133 #
Council position
Article 1 – paragraph 1
Article 1 – paragraph 1
1. This Directive provides rules for facilitating theaims at complementing the existing framework on the coordination of social security systems, Regulation EC (No) 883/2004, with a view to application of patients' rights in the context of access to safe and, high- quality cross-border healthcare and promotes cooperation on healthcare between Member States, in full respect of national competencies in organising and delivering healthcareand efficient cross-border healthcare, in full respect of national competencies in organising and delivering healthcare. This Directive establishes a general framework for patients' rights regarding cross-border mobility.
Amendment 135 #
Council position
Article 1 – paragraph 1 a (new)
Article 1 – paragraph 1 a (new)
1a. Within this general framework Member States themselves retain responsibility for providing safe, high quality, efficient and quantitatively adequate healthcare to citizens on their territory. On no account may Member States dismantle their own health care due to its also being available in other Member States. Moreover, this Directive shall leave the choice of where to obtain healthcare to the patients and shall not have the result of creating policies that encourage patients in any way whatsoever to go to another Member State to obtain healthcare.
Amendment 136 #
Council position
Article 1 – paragraph 2
Article 1 – paragraph 2
2. This Directive shall apply to the provision of healthcare to patients and care of the elderly, regardless of how it is organised, delivered and financed.
Amendment 145 #
Council position
Article 4 – paragraph 2 – point a
Article 4 – paragraph 2 – point a
(a) patients receive upon request relevant information on the standards and guidelines referred to in paragraph 1, including provisions on supervision and assessment of healthcare providers, and information on which healthcare providers are subject to these standards and guidelines, as well as information on the potential risks of cross-border healthcare;
Amendment 149 #
Council position
Article 4 – paragraph 2 – point c
Article 4 – paragraph 2 – point c
(c) there are transparent complaints procedures and mechanisms for patients to seek remedies, which are free of charge and in accordance with the legislation of the Member State of treatment if they become aware of or suffer harm arising from the healthcare they receive;
Amendment 149 #
Proposal for a directive
Recital 31
Recital 31
(31) The evidence available indicates that the application of free movement principles regarding use of healthcare in another Member State within the limits of the cover guaranteed by the statutory sickness insurance scheme of the Member State of affiliation will not undermine the health systems of the Member States or financial sustainability of their social security systems. However, the Court of Justice has recognised that it cannot be excluded that the possible risk of seriously undermining a social security system's financial balance or the objective of maintaining a balanced medical and hospital service open to all may constitute overriding reasons in the general interest capable of justifying a barrier to the principle of freedom to provide servicesof movement. The Court of Justice has also recognised that the number of hospitals, their geographical distribution, the way in which they are organised and the facilities with which they are provided, and even the nature of the medical services which they are able to offer, are all matters for which planning must be possible. This Directive should provide for a system of prior authorisation for assumption of costs for hospital care received in another Member State, where the following conditions are met : had the treatment been provided on its territory, it would have been assumed by its social security system and the consequent outflow of patients due to the implementation of the directive seriously undermines or is likely to seriously undermine the financial balance of the social security system and/or this outflow of patients seriously undermines, or is likely to seriously undermine the planning and rationalisation carried out in the hospital sector to avoid hospital overcapacity, imbalance in the supply of hospital care and logistical and financial wastage, the maintenance of a balanced medical and hospital service open to all, or the maintenance of treatment capacity or medical competence on the territory of the concerned Member. As the assessment of the precise impact of an expected outflow of patients requires complex assumptions and calculations, the Directive allows for a system of prior authorisation if there is sufficient reason to expect that the social security system will be seriously undermined. This should also cover cases of already existing systems of prior authorisation which are in conformity with conditions laid down in Article 8.
Amendment 151 #
Council position
Article 4 – paragraph 2 – point f a (new)
Article 4 – paragraph 2 – point f a (new)
(fa) healthcare providers do not deny healthcare to any patient, whether they be a citizen of the same or of another Member State, on account of the socio- economic position of the patient;
Amendment 165 #
Proposal for a directive
Recital 37
Recital 37
(37) Realising the potential of the internal market for cCross-border healthcare requires cooperation between providers, purchasers and regulators of different Member States at national, regional or local level in order to ensure safe, high quality and efficient care across borders. This is particularly the case for cooperation in border regions, where cross-border provision of services may be the most efficient way of organising health services for the local populations, but where achieving such cross-border provision on a sustained basis requires cooperation between the health systems of different Member States. Such cooperation may concern joint planning, mutual recognition or adaptation of procedures or standards, interoperability of respective national information and communication technology systems, practical mechanisms to ensure continuity of care or practical facilitating of cross- border provision of healthcare by health professionals on a temporary or occasional basis. Directive 2005/36/EC on the recognition of professional qualifications stipulates that free provision of services of a temporary or occasional nature, including services provided by health professionals, in another Member State should not, subject to specific provisions of Community law, be restricted for any reason relating to professional qualifications. This Directive should be without prejudice to those provisions of Directive 2005/36/EC.
Amendment 189 #
Proposal for a directive
Article 1
Article 1
This Directive establishes a general framework for the provision of safe, high quality and efficient cross-border healthcareaims at complementing the existing framework on the coordination of social security systems (Regulation 1408/71/EC and its successor Regulation 883/2004/EC) with a view to application of patients' rights in the context of the provision of safe, high quality and efficient cross-border healthcare. This Directive establishes a general framework for patients' rights regarding cross-border mobility.
Amendment 193 #
Proposal for a directive
Article 1
Article 1
This Directive establishes a general framework for the provision of safe, high quality and efficient cross-borderprovides rules for the access to safe and high quality healthcare in another Member State and establishes cooperation mechanisms on healthcare between Member States, in full respect of national competencies in organising and delivering healthcare.
Amendment 205 #
Proposal for a directive
Article 1 - subparagraph 1 a (new)
Article 1 - subparagraph 1 a (new)
Within this general framework Member States themselves retain responsibility for providing safe, high quality, efficient and quantitatively sufficient health care to citizens within their territory. On no account may Member States dismantle health care because it is also available in other Member States. This Directive must on no account encourage Member States to dismantle their own health care. Moreover, this Directive must not have the result of encouraging patients in any way whatsoever to go to another Member State to obtain health care.
Amendment 231 #
Proposal for a directive
Article 3 - paragraph 2
Article 3 - paragraph 2
Amendment 258 #
Proposal for a directive
Article 4 - point (b)
Article 4 - point (b)
(b) "cross-border healthcare" means healthcare provided in a Member State other than that where the patient is an insured person or healthcare provided in a Member State other than that where the healthcare provider resides, is registered or is established;
Amendment 319 #
Proposal for a directive
Article 5 – paragraph 1 – point -a (new)
Article 5 – paragraph 1 – point -a (new)
(-a) care providers do not deny health care to any patient, whether they be a citizen of the same or of another Member State, on account of the socio-economic position of the patient;
Amendment 325 #
Proposal for a directive
Article 5 – paragraph 1 – point a
Article 5 – paragraph 1 – point a
(a) mechanisms are in place for ensuring that healthcare providers and medical emergency services are able to meet such standards, taking into account international medical science and generally recognised good medical practices;
Amendment 334 #
Proposal for a directive
Article 5 – paragraph 1 – point b
Article 5 – paragraph 1 – point b
(b) the application of such standards by healthcare providers and medical emergency services in practice is regularly monitored and corrective action is taken when appropriate standards are not met, taking into account progress in medical science and health technology;
Amendment 340 #
Proposal for a directive
Article 5 – paragraph 1 – point c
Article 5 – paragraph 1 – point c
(c) healthcare providers provide all relevant information to enable patients to make an informed choice, in particular on availability, quality, safety, prices and outcomes of the healthcare provided and details of their insurance cover or other means of personal or collective protection with regard to professional liability;
Amendment 346 #
Proposal for a directive
Article 5 – paragraph 1 – point d
Article 5 – paragraph 1 – point d
(d) patients have athe means of making complaints and arethere are free of charge mechanisms in place to guaranteed remedies and compensation when they suffer harm or become aware of harm caused arising from the healthcare they receive;
Amendment 380 #
Proposal for a directive
Article 6
Article 6
1. Subject to the provisions of this Directive, in particular Articles 6, 7, 8 and 9, the Member State of affiliation shall ensure that insured persons travelling to another Member State with the purpose of receiving healthcare there or seeking to receive healthcare provided in another Member State, will not be prevented from receiving healthcare provided in another Member State where the treatment in question is among the benefits provided for by the legislation of the Member State of affiliation to which the insured person is entitled. The Member State of affiliation, in accordance with the same mechanisms provided for in Regulation (EEC) No 1408/71 and its successor Regulation (EC) No 883/2004. 2. Member States shall reimbensurse the costs to the insured person, which would have been paid for by its statutory social security system had the same or similar healthcare been provided in its territory. In any event, it is for the Member State of affiliation to determine the healthcare that is paid for regardless of where it is provided. 2. The costs of healthcare provided in anotherat physicians and service providers which are working as contract partners of their respective national health systems or statutory social security systems are obliged to accept the European Health Insurance Card (EHIC) and Form E-112 and treat patients showing their EHIC on the same conditions as stipulated by the Regulation on the coordination of social security systems. Member States shall be reimbursed by the Member State of affiliation in accordance with the provisions of this Directive up to the level of costs that would have been assumed had the same or similar healthcare been provided in the Member State of affiliation, without exceeding the actual costs of healthcare receivedoblige service providers to post an EHIC symbol in the lobby of the service provider (in a similar way to credit cards in shops and restaurants) to indicate that the EHIC is accepted there in line with that Regulation. 3. The Member State of affiliation may impose on a patient seeking healthcare provided in another Member State, the same conditions, criteria of eligibility and regulatory and administrative formalities for receiving healthcare and reimbursement of healthcare costs as it would impose if the same or similar healthcare was provided in its territory, in so far as they are neither discriminatory nor an obstacle to freedom of movement of persons. 45. Member States shall have a mechanism for calculation of costs that are to be reimbursed to the insured person by the statutory social security system for healthcare provided in another Member State. This mechanism shall be based on objective, non-discriminatory criteria known in advance and the costs reimbursed according to this mechanism shall be not less than what would have been assumed had the same or similar healthcare been provided in the territory of the Member State of affiliation. 5. Patients travelling to another Member State with the purpose of receiving healthcare therePatients receiving healthcare in Member State other than their Member State of affiliation or seeking to receive healthcare provided in another Member State shall be guaranteed access to their medical records, in conformity with national measures implementing Community provisions on the protection of personal data, in particular Directives 95/46/EC and 2002/58/EC.
Amendment 417 #
Proposal for a directive
Article 6 – paragraph 3 a (new)
Article 6 – paragraph 3 a (new)
3a. Members States shall ensure that physicians and service providers which are working as contract partners of their respective national health systems or statutory social security systems are prohibited from treating patients from another Member State on a private basis or demanding upfront cash payments from them, where the patient can prove her or his status as an insured person of the respective statutory social security system of the respective Member State of affiliation by the European health Insurance Card and Form E-112.
Amendment 440 #
Proposal for a directive
Article 8
Article 8
Article 8 is deleted
Amendment 510 #
Proposal for a directive
Article 9 – paragraph 1
Article 9 – paragraph 1
1. The Member State of affiliation shall ensure that administrative procedures regarding the use of healthcare in another Member State related to any prior authorisation referred to in Article 8(3), reimbursement22(1)(c) and Article 22(2) of Regulation 1408/71, coverage of costs of healthcare incurred in another Member State and other conditions and formalities referred to in Article 6(31), are based on objective, non- discriminatory criteria which are published in advance, and which are necessary and proportionate to the objective to be achieved. In any event, an insured person shall always be granted the authorisation pursuant to Regulations on coordination of social security referred to in Art. 3.1 f) whenever the conditions of Art.22.1 c) and Art. 22.2 of Regulation 1408/71 are met.
Amendment 521 #
Proposal for a directive
Article 9 – paragraph 3
Article 9 – paragraph 3
3. Member States shall specify in advance and in a transparent way the criteria for refusal of the prior authorisation referred to in Article 8(3).