Health in an Enlarged EU
Kangaroo seminar on Health and EU Enlargement - February 5th 2003
Enlargement brings many challenges to the rest of the EU. An equivalent level of health care and public health standards will be one more to add to the long list.
Central and Eastern European Countries, although under their former communist regimes had relatively sophisticated health systems reflected by the still large number of doctors they possess per capita, have over the last decade fallen behind due to a scarcity of resources in their shrinking economies as they had to readjust after the collapse of the Comecon system and the introduction of market economies.
One area where former communist regimes were not so advanced was in Environmental standards particularly pollution and this has markedly deteriorated over the last decade as other areas became economic priorities. Consequently the populations have suffered in terms of respiratory and cardiovascular problems etc. Infectious diseases from TB (and worryingly the drug-resistant variety in particular) to HIV-Aids have become commoner in these countries as economic poverty mixed with exposure to the worst western habits have caused rises in prostitution, drug and alcohol abuse, poorer diets, as well as poor housing conditions. This is reflected in the significant differences in life expectancy. For the EU; men 74.5 women 81.2, as opposed to EU candidates; men 67.4 and women 75.8.
Obviously EU membership will bring through the Acquis legal obligations to harmonise upwards all areas concerning the quality of air, water, food and blood products as well as Health and Safety Rules at work and consumer protection. This will have a dramatic affect on the health of the target populations. Already large sums of money have been spent through the various pre-accession Programmes such as PHARE to effect these changes. An invitation is extended to participate in the 2001-2006 Community Public Health Programmes but take-up is low. The EIB with the WHO is active in investing in the European Observatory on Health Care Systems as well as improving mental and neurological services in candidate countries. Furthermore the monitoring roles of the new various Agencies from the Food Safety Agency to the Environment Agency will have their role to play as well in improving the Heath and Safety of the population. The European Centre for Drugs and Drug Addiction is in receipt of PHARE funds to help reduce drug addiction in these countries.
Provision of Health Services in all EU member states is by Treaty a preserve of the member states even if in apparent contradiction that the right to medical care is enshrined in the European Charter of Fundamental Rights. This is unlikely to change in the Constitutional Conventions deliberations. Similarly although a single market in pharmaceuticals exists in theory, individual member states regulate prices in order to contain costs, and ensure access to medicines within prescribed budgets. Nevertheless all EU markets will now become automatically accessible to new pharmaceutical products which are licensed under the common EU wide procedures or mutual recognition procedures of the EMEA based in London. This too should improve survival rates particularly in areas like chemotherapy for cancer and HIV Aids.
The EU has a limited direct role in Health as Article 152 of the Amsterdam Treaty does provide a complimentary role of Public Health and Health Promotion for the EU. The Public Health Action Programme run by the Commission with support from national governments will involve money being spent in new EU member states in promoting best practice in priority health areas and setting-up systems of rapid alert in the event of a threat to safety.
Following the Decker and Kohll judgments at the European Court of Justice in 1998 - which gave two Luxembourgers the right to claim the costs of spectacles and false teeth from their government after receiving treatment in Germany and France - residents in new EU member states buying similar medical appliances, including hearing aids, are entitled to present the bill to their own Governments. Following a separate judgment of the court last year all EU citizens facing unreasonable delay in receiving local treatment are entitled to receive treatment in other EU countries- all this may pose a budgetary problem if too many people go on cross border health tourism. There are already serious concerns that the free movement of people which will shortly come about will pose a risk as more infectious disease is spread to the West and also a feared flight of qualified health professionals to the better paid shortage skill areas in the west.
Of course all candidate countries sign-up to the following WHO Regional Committee for Europe 21 Targets for the 21st Century:
"By the year 2010 Member States should have sustainable financing and resource allocation mechanisms for health care based on principles of equal access, cost-effectiveness, solidarity, and optimum quality."
Indicator: Total health expenditure as a percentage of gross national product-current EU average 8.75% verses 5.8% in the candidates.
There is a correlation between health spending and GDP per capita. Rich countries spend proportionally more on health than poorer ones. Therefore in all probability the single biggest improvement in Health care to our new member states' citizens will no doubt come about as a result of the undoubted prosperity and economic growth they will enjoy. They will be able to spend more on medical care in their national budgets, enjoy better and healthier diets, more leisure time as well as cleaner and safer living and work environments. Their future is a healthy one over the coming years.