BETA


2006/2275(INI) Impact and consequences of the exclusion of Health Services from the Directive on Services in the Internal Market

Progress: Procedure completed

RoleCommitteeRapporteurShadows
Lead IMCO VERGNAUD Bernadette (icon: PSE PSE)
Committee Opinion EMPL ETTL Harald (icon: PSE PSE)
Committee Opinion ENVI MAATEN Jules (icon: ALDE ALDE)
Lead committee dossier:
Legal Basis:
RoP 54

Events

2007/09/05
   EC - Commission response to text adopted in plenary
Documents
2007/06/14
   EC - Commission response to text adopted in plenary
Documents
2007/05/23
   EP - Results of vote in Parliament
2007/05/23
   EP - Decision by Parliament
Details

The European Parliament adopted a resolution based on the own-initiative report by Bernadette Vergnaud (PES, FR) on the impact and consequences of the exclusion of health services from the Directive on services in the internal market. The report was adopted by 514 votes in favour to 132 against with 8 abstentions.

Cross-border mobility of patients and health professionals will increase in future, thus giving patients more choice. Parliament felt that, whatever their level of income or place of residence, all European citizens should be guaranteed equal and affordable access to health care, in accordance with the principles of universality, quality, safety, continuity and solidarity. Parliament stressed that Member States should treat residents of another Member State on an equal basis with regard to access to health services, regardless of whether they are private or public patients.

Member States did not sufficiently promote health care, as a result of which patients’ rights were restricted. Parliament recalled that the Member States that had implemented the existing case law of the Court of Justice had not experienced any major increase in health care budgets as a result of patients" increased mobility. Whilst health care systems are not a competence of the Community, issues relating to health care systems, such as access to medicines and treatments, patient information, and the movement of insurance companies and health professionals, had a cross-border character, and those issues need to be addressed by the Union.

Parliament was of the opinion that patients" safety and rights were not ensured in the cross-border provision of health care at present and that legal uncertainty existed regarding reimbursement mechanisms, obligations for national authorities to share regulatory information, the duty of care for both the initial and the follow-up treatment and risk management provisions for private patients.

It requested a clear definition of health services , so as to clarify and clearly demarcate the scope of application of future legislation in this field, and stated that any Community action relating to health care services should be consistent with Community action relating to social services of general interest.

Parliament considered that it was important to give patients the right to choose health care in another Member State when this allows them to receive appropriate treatment. Patients need to be informed fully of both the terms and prior conditions for access to and the implications of that choice. According to case law of the Court of Justice, prior authorisation for hospital care should be easily obtainable, dealt with immediately and evaluated on the basis of objective criteria. Refusal of authorisation should be justified on the basis of objective criteria which must be verified in a transparent way. Parliament called for the adoption of a European charter of patients' rights on the basis of existing charters in the Member States and of work carried out by non-governmental organisations.

It also called for a codification of existing case law on the reimbursement of cross-border health care in order to ensure the proper application of that case law by all Member States and to improve the information available to patients, national insurance schemes and health care providers without creating additional cumbersome bureaucratic burdens for Member States. It should be possible for the Commission to start proceedings against Member States that fail to apply the existing procedures for reimbursement of cross-border health care. A European reference scheme should be put in place concerning reimbursement in order to allow citizens to make comparisons and to make a choice as to which treatment is most suitable for them.

There must be an examination of ways of actively supporting work aimed at making use of the European Health Insurance Card ("EHIC"), containing a standardised set of electronic patient data, in order to simplify procedures for European citizens to obtain health care in other Member States. The holders of an EHIC must determine themselves the data which will appear on it. There must be a high level of data protection for patients as regards cross-border cooperation in health services in order to ensure confidentiality of sensitive medical data.

The Commission was asked to set up a system for collecting data and exchanging information between the various national authorities on health care providers, and to set up a European card to provide access to information on the skills of health care professionals. That information should be available to patient. In the context of increased professional mobility in Europe, the Commission was asked to establish a legal duty for national authorities to exchange registration and disciplinary information about health care professionals in order to ensure patient safety.

Parliament insisted that patient mobility needed the safeguards of clear rules governing liability for the provision of cross-border health services and the resultant need for ease of access to redress and judicial mechanisms, particularly if the various stages of treatment have taken place in more than one Member State. It called for clarification of liabilities in the event of injury and for an obligation for all health professionals to have compulsory third-party liability insurance at reasonable cost.

Parliament considered that closer cooperation between health systems on the local, regional, intergovernmental and European levels should make it possible to obtain appropriate treatment in other Member States, improve the quality of services and thus increase citizens’ confidence.

The Commission was asked to draw up technical standards on the introduction of interoperable transparent information systems allowing effective exchange and sharing of information on health between health care providers in different Member States. Parliament encouraged the development of networks of reference centres, including electronic reference centres that deal with rare, specific and chronic diseases, and the exchange of knowledge between Member States on best practices with regard to treatment and the organisation of health care systems. It called for the creation of a point of single contact, on the basis of existing Community instruments, in accordance with the organisational peculiarities of each health care system, to guarantee access to independent information for patients, health professionals, health care institutions and competent authorities.

In conclusion, Parliament asked the Commission to do the following:

- to strengthen its policy of pursuing violations of EU law with a view to ensuring that all Member States comply with the case law of the Court of Justice and that all European patients, irrespective of their country of origin, benefit from the rights conferred on them by the Treaty;

- to submit a proposal for an appropriate instrument with a view, in particular, to codifying the case law of the Court of Justice;

- to submit a proposal taking into account this resolution and ECJ rulings on patients´ rights. Parliament called for a guarantee for patients of the greatest possible access to health care services all over Europe as well as a guarantee for health service providers of the freedom to provide services and the freedom of establishment;

- given that the Commission proposal to deal with health issues in Directive 2006/123/EC (the Services Directive) was not accepted by the European Parliament and the Council, Parliament insisted that further action was now required to preserve existing rights, and consequently, called on the Commission, as the guardian of the Treaties, to guarantee the safeguarding of those rights;

Lastly, it stated that a new European regulatory framework for cross-border health care should improve access to high-quality health care in the event of illness, contribute to patient safety and increase the number of choices available to all patients in the EU, without increasing inequality in health care outcomes.

Documents
2007/05/23
   EP - End of procedure in Parliament
2007/05/21
   EP - Debate in Parliament
2007/05/10
   EP - Committee report tabled for plenary, single reading
Documents
2007/05/10
   EP - Committee report tabled for plenary
Documents
2007/05/08
   EP - Vote in committee
Details

The committee on Internal market and Consumer protection adopted the initiative report drafted by Bernadette VERGNAUD (PSE, FR) on the consequences of the exclusion of health services from the Directive on services in the internal market.

Bearing in mind the progressive increase in cross-border mobility of patients and health professionals, MEPs agreed that - whatever their level of income or place of residence - all European citizens should be guaranteed equal and affordable access to health care, regardless of whether they go public or private, in accordance with the principles of universality, quality, safety, continuity, solidarity, thus contributing to the social and territorial cohesion of the Union while ensuring the financial sustainability of national health-care systems. That said, while patients should be free to choose health care in another country, medical tourism should not be actively encouraged. Moreover, the Committee argued that patient mobility cannot be allowed to grow unchecked without concurrent and clear rules governing liability for the provision of cross-border health services.

On the issue of reimbursement of cross-border health care , the report calls for: a codification of existing case law on the reimbursement of cross-border health care in order to ensure the proper application of the case law by all Member States; a European reference scheme to be put in place concerning reimbursement in order to allow citizens to make a comparison and to make the most suitable choice of the treatment for them; examination of ways of actively supporting and promoting the work aimed at making use of the European Health Insurance Card with a standardised set of electronic patient data common practice, in order to simplify the procedures for European citizens obtaining health care in other Member States and to ensure confidentiality of sensitive medical data.

The Committee considers that closer cooperation between health systems on local, regional, intergovernmental and European levels should make it possible to obtain appropriate treatment in other Member States, improve the quality of services and thus increase citizens’ confidence. The Commission is invited to actively support the introduction of interoperable transparent information systems allowing effective exchange and sharing of information on health between health-care providers in individual Member States. It encourages the development of networks of reference centres, including electronic reference centres that deal with some rare, specific and chronic diseases, and exchange of knowledge between various EU countries on best treatment practices and the organisation of health-care systems.

The Commission is invited to encourage the Member States to actively support the introduction of E-health and telemedicine.

Noting how difficult it is for patients to obtain clear and precise information on health care, especially in relation to cross-border health care, and the complexity of the procedures that have to be followed, the Committee calls for the creation and use of a single point of contact on the basis of existing Community instruments, in accordance with the specificity of the organisation of each health-care system, to guarantee access to objective and independent information for patients, health professionals, health-care institutions and the competent authorities.

As regards the issue of health being given a place in the Services Directive, the Committee emphasises that Treaty rules, including the specific provisions on services of a general economic interest, as well as the jurisprudence of the ECJ, apply to health services and stresses that health-service providers are fully entitled to establish and to provide services in any Member State, following national and EU rules. It also emphasises that patients are fully entitled to seek health care in any Member State. In adopting an amendment drafted by Toine MANDERS (ALDE, NL), members of the Committee invited the Commission to present a proposal to reintroduce health services into Directive 2006/123/EC - i.e. the Services Directive.

In the same vein, the Committee turned down the rapporteur's call for a separate directive on health services, choosing instead to ask the Commission to propose an appropriate instrument with a view, in particular, to codifying the pertinent case law of the ECJ. Due to the adoption of these amendments, the rapporteur voted against the final report.

2007/04/24
   EP - Amendments tabled in committee
Documents
2007/03/30
   EP - Amendments tabled in committee
Documents
2007/03/26
   EP - Committee opinion
Documents
2007/03/23
   EP - Committee opinion
Documents
2007/03/06
   EP - Committee draft report
Documents
2006/11/29
   EP - Committee referral announced in Parliament
2006/11/28
   EP - MAATEN Jules (ALDE) appointed as rapporteur in ENVI
2006/11/22
   EP - VERGNAUD Bernadette (PSE) appointed as rapporteur in IMCO
2006/11/22
   EP - ETTL Harald (PSE) appointed as rapporteur in EMPL

Documents

  • Commission response to text adopted in plenary: SP(2007)3608/2
  • Commission response to text adopted in plenary: SP(2007)3179
  • Results of vote in Parliament: Results of vote in Parliament
  • Decision by Parliament: T6-0201/2007
  • Debate in Parliament: Debate in Parliament
  • Committee report tabled for plenary, single reading: A6-0173/2007
  • Committee report tabled for plenary: A6-0173/2007
  • Amendments tabled in committee: PE388.510
  • Amendments tabled in committee: PE386.640
  • Committee opinion: PE382.461
  • Committee opinion: PE382.474
  • Committee draft report: PE386.390
  • Committee draft report: PE386.390
  • Committee opinion: PE382.474
  • Committee opinion: PE382.461
  • Amendments tabled in committee: PE386.640
  • Amendments tabled in committee: PE388.510
  • Committee report tabled for plenary, single reading: A6-0173/2007
  • Commission response to text adopted in plenary: SP(2007)3179
  • Commission response to text adopted in plenary: SP(2007)3608/2

Activities

Votes

Rapport Vergnaud A6-0173/2007 - am. 10 #

2007/05/23 Outcome: -: 545, +: 104, 0: 12
CY IE LU MT LV SI EE FI DK CZ SE EL BE AT NL LT BG SK PT HU RO IT FR ES DE PL GB
Total
4
4
6
4
8
6
6
12
14
21
17
18
19
17
27
12
13
14
22
20
32
53
66
40
88
50
68
icon: Verts/ALE Verts/ALE
39

Luxembourg Verts/ALE

For (1)

1

Latvia Verts/ALE

1

Finland Verts/ALE

For (1)

1

Denmark Verts/ALE

For (1)

1

Sweden Verts/ALE

Abstain (1)

1

Belgium Verts/ALE

2

Austria Verts/ALE

2

Italy Verts/ALE

2

Spain Verts/ALE

2

United Kingdom Verts/ALE

5
icon: GUE/NGL GUE/NGL
33

Cyprus GUE/NGL

2

Finland GUE/NGL

For (1)

1

Denmark GUE/NGL

1

Sweden GUE/NGL

2

Greece GUE/NGL

Abstain (1)

2

Netherlands GUE/NGL

2

Portugal GUE/NGL

3

France GUE/NGL

2
icon: ITS ITS
15

Belgium ITS

2

Austria ITS

For (1)

1

United Kingdom ITS

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1
icon: NI NI
11

Czechia NI

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1

Slovakia NI

Abstain (1)

3

Italy NI

Abstain (1)

2
2

United Kingdom NI

For (1)

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Abstain (1)

3
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21

Ireland IND/DEM

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1

Czechia IND/DEM

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1

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2

Greece IND/DEM

1

Netherlands IND/DEM

2

Poland IND/DEM

3
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32

Ireland UEN

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1

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1

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2
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87

Cyprus ALDE

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2

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2

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2

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2
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3

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3

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1

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Rapport Vergnaud A6-0173/2007 - am. 12 #

2007/05/23 Outcome: -: 543, +: 110, 0: 4
CY IE EE LU MT SI DK LV FI SK CZ SE EL NL BE LT PT AT BG FR HU IT ES RO PL DE GB
Total
4
4
6
6
4
6
13
9
12
14
21
16
17
27
16
12
23
17
13
65
22
52
39
33
50
88
68
icon: Verts/ALE Verts/ALE
39

Luxembourg Verts/ALE

For (1)

1

Denmark Verts/ALE

For (1)

1

Latvia Verts/ALE

1

Finland Verts/ALE

For (1)

1

Sweden Verts/ALE

For (1)

1

Belgium Verts/ALE

2

Austria Verts/ALE

2

Italy Verts/ALE

2

Spain Verts/ALE

2

United Kingdom Verts/ALE

5
icon: GUE/NGL GUE/NGL
33

Cyprus GUE/NGL

2

Denmark GUE/NGL

1

Finland GUE/NGL

For (1)

1

Sweden GUE/NGL

2

Greece GUE/NGL

2

Netherlands GUE/NGL

2

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3

France GUE/NGL

2
icon: NI NI
11

Czechia NI

1
2
2

United Kingdom NI

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3
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18

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1

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2

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1

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3
icon: ITS ITS
15

Austria ITS

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1

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1
icon: UEN UEN
31

Ireland UEN

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1

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1

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2
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86

Cyprus ALDE

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1

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2

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3

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2

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2
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185

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3

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2

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3

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Rapport Vergnaud A6-0173/2007 - am. 18/1 #

2007/05/23 Outcome: -: 563, +: 100, 0: 3
CY MT IE LU SE SI EE LV FI DK LT CZ AT NL EL BE BG SK PT HU RO IT ES FR PL DE GB
Total
4
4
3
6
17
6
6
9
12
14
10
21
17
27
18
20
14
14
23
22
33
51
40
67
50
90
68
icon: Verts/ALE Verts/ALE
40

Luxembourg Verts/ALE

For (1)

1

Sweden Verts/ALE

For (1)

1

Latvia Verts/ALE

1

Finland Verts/ALE

For (1)

1

Denmark Verts/ALE

For (1)

1

Austria Verts/ALE

2

Belgium Verts/ALE

2

Italy Verts/ALE

2

Spain Verts/ALE

2

United Kingdom Verts/ALE

5
icon: GUE/NGL GUE/NGL
33

Cyprus GUE/NGL

2

Sweden GUE/NGL

2

Finland GUE/NGL

For (1)

1

Denmark GUE/NGL

1

Netherlands GUE/NGL

2

Greece GUE/NGL

2

Portugal GUE/NGL

3

France GUE/NGL

2
icon: ITS ITS
18

Austria ITS

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1

Belgium ITS

2

Bulgaria ITS

1

United Kingdom ITS

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1
icon: NI NI
11

Czechia NI

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1

Slovakia NI

Abstain (1)

3
2
2

United Kingdom NI

For (1)

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3
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2

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1

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1

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2

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1

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3
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31

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1

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1

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2
icon: ALDE ALDE
84

Cyprus ALDE

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1

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2

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2
2
icon: PSE PSE
189

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2

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Rapport Vergnaud A6-0173/2007 - am. 9/1 #

2007/05/23 Outcome: -: 372, +: 291, 0: 5
FR BE AT IT LU MT ES IE DK EE PT BG NL SK SI CY SE HU FI EL LV LT RO CZ GB DE PL
Total
65
21
17
52
6
4
39
4
14
6
23
14
27
14
6
4
16
22
12
18
9
12
33
21
69
90
50
icon: PSE PSE
187

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1

Malta PSE

2

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3

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1

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2

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2

Czechia PSE

For (1)

1
icon: Verts/ALE Verts/ALE
40

Belgium Verts/ALE

2

Austria Verts/ALE

2

Italy Verts/ALE

2

Luxembourg Verts/ALE

For (1)

1

Spain Verts/ALE

2

Denmark Verts/ALE

For (1)

1

Sweden Verts/ALE

Abstain (1)

1

Finland Verts/ALE

For (1)

1

Latvia Verts/ALE

1

United Kingdom Verts/ALE

5
icon: NI NI
11

Italy NI

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2

Czechia NI

1

United Kingdom NI

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Abstain (1)

3
2
icon: IND/DEM IND/DEM
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2

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1

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1

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2

Sweden IND/DEM

2

Greece IND/DEM

1

Czechia IND/DEM

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1

Poland IND/DEM

3
icon: ITS ITS
17

Belgium ITS

2

Austria ITS

Against (1)

1

Bulgaria ITS

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1

United Kingdom ITS

Against (1)

1
icon: UEN UEN
32

Ireland UEN

Against (1)

1

Denmark UEN

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1

Lithuania UEN

2
icon: GUE/NGL GUE/NGL
33

France GUE/NGL

2

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1

Portugal GUE/NGL

3

Netherlands GUE/NGL

2

Cyprus GUE/NGL

2

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2

Finland GUE/NGL

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1

Greece GUE/NGL

2
icon: ALDE ALDE
87

Belgium ALDE

4

Austria ALDE

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1

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1

Spain ALDE

2

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For (1)

1

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2

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4

Slovenia ALDE

2

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1

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2

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2

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1
icon: PPE-DE PPE-DE
240

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3

Malta PPE-DE

2

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1

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1

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3

Cyprus PPE-DE

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Latvia PPE-DE

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1

Rapport Vergnaud A6-0173/2007 - am. 9/2 #

2007/05/23 Outcome: -: 394, +: 256, 0: 8
FR BE LU MT ES AT EE PT IE DK SK BG CY EL SI SE HU FI NL LT LV IT RO CZ GB DE PL
Total
64
21
6
4
38
17
6
23
4
14
13
14
4
17
5
16
22
12
27
11
9
50
33
21
67
89
51
icon: PSE PSE
188

Luxembourg PSE

For (1)

1

Malta PSE

2

Estonia PSE

3

Finland PSE

2

Lithuania PSE

2

Czechia PSE

For (1)

1
icon: Verts/ALE Verts/ALE
38

Belgium Verts/ALE

2

Luxembourg Verts/ALE

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1

Spain Verts/ALE

1

Austria Verts/ALE

2

Denmark Verts/ALE

For (1)

1

Sweden Verts/ALE

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1

Finland Verts/ALE

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1

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1

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2

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4
icon: NI NI
10

Slovakia NI

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2

Italy NI

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2

Czechia NI

1

United Kingdom NI

Against (2)

Abstain (1)

3
2
icon: ITS ITS
18

Belgium ITS

2

Austria ITS

Against (1)

1

Bulgaria ITS

Against (1)

1

United Kingdom ITS

Against (1)

1
icon: IND/DEM IND/DEM
20

France IND/DEM

Against (1)

1

Ireland IND/DEM

Against (1)

1

Denmark IND/DEM

Against (1)

1

Greece IND/DEM

1

Sweden IND/DEM

2

Netherlands IND/DEM

2

Czechia IND/DEM

Against (1)

1

Poland IND/DEM

3
icon: GUE/NGL GUE/NGL
32

France GUE/NGL

2

Portugal GUE/NGL

3

Denmark GUE/NGL

1

Cyprus GUE/NGL

2

Greece GUE/NGL

2

Sweden GUE/NGL

2

Finland GUE/NGL

Against (1)

1

Netherlands GUE/NGL

2
icon: UEN UEN
32

Ireland UEN

Against (1)

1

Denmark UEN

Against (1)

1

Lithuania UEN

2
icon: ALDE ALDE
84

Belgium ALDE

For (1)

4

Luxembourg ALDE

For (1)

1

Spain ALDE

2

Austria ALDE

Against (1)

1

Estonia ALDE

Against (2)

2

Ireland ALDE

For (1)

1

Cyprus ALDE

Against (1)

1

Slovenia ALDE

2

Sweden ALDE

Against (2)

2

Hungary ALDE

2

Latvia ALDE

Against (1)

1
icon: PPE-DE PPE-DE
236

Luxembourg PPE-DE

Against (1)

3

Malta PPE-DE

2

Estonia PPE-DE

Against (1)

1

Ireland PPE-DE

Against (1)

1

Denmark PPE-DE

Against (1)

1

Cyprus PPE-DE

Against (1)

1

Slovenia PPE-DE

3

Lithuania PPE-DE

1

Latvia PPE-DE

3

Rapport Vergnaud A6-0173/2007 - ams. 1+19+31 #

2007/05/23 Outcome: +: 574, -: 54, 0: 6
DE GB FR ES IT PL RO NL PT BE SE HU AT EL FI BG LV LT SK SI LU IE CY EE MT DK CZ
Total
90
69
63
39
36
47
33
27
20
20
17
21
16
14
12
13
9
11
14
6
6
4
4
6
4
13
20
icon: PPE-DE PPE-DE
227

Lithuania PPE-DE

1

Slovenia PPE-DE

3

Luxembourg PPE-DE

3

Ireland PPE-DE

For (1)

1

Cyprus PPE-DE

1

Estonia PPE-DE

For (1)

1

Malta PPE-DE

2

Denmark PPE-DE

For (1)

1
icon: PSE PSE
182

Finland PSE

2

Lithuania PSE

2

Slovenia PSE

For (1)

1

Luxembourg PSE

For (1)

1

Estonia PSE

Against (1)

3

Malta PSE

2

Czechia PSE

For (1)

1
icon: ALDE ALDE
80

Belgium ALDE

Against (1)

Abstain (1)

4

Sweden ALDE

2
2

Austria ALDE

1

Bulgaria ALDE

3

Latvia ALDE

1

Slovenia ALDE

2

Luxembourg ALDE

For (1)

1

Ireland ALDE

For (1)

1

Cyprus ALDE

For (1)

1

Estonia ALDE

2

Denmark ALDE

3
icon: Verts/ALE Verts/ALE
40

Germany Verts/ALE