Europe’s public service unions have urged European Union health ministers to redraft a highly controversial proposal to permit cross-border healthcare in order to ensure that its legal basis does not relate simply to patients’ ability to pay.

In Brussels yesterday, the annual congress of the European Federation of Public Services Unions (EPSU) stated that the proposed directive must be based legally on the principles of public health - which are covered by Article 152 of the EU Treaty - and not just those of the internal market (Article 95).

Critics claim that the directive, as it currently stands, would impose market mechanisms on the health care systems of individual nations, putting them in competition with each other for patients, and that the health budgets of smaller nations could be wrecked if large numbers of foreign patients arrive seeking treatment. The net effect would be to force costs up and standards down, they warn.

“We cannot let market forces run healthcare systems or we will end up with a two-tier system of healthcare delivery,” said Karen Jennings, who chairs the EPSU health care committee and is head of health at the UK public service union Unison.

In April, the European Parliament backed the proposed directive permitting EU citizens to seek cross-border healthcare on a 297-120 vote but with 152 abstentions, which included the entire Socialist group of MEPs. Since then, intense negotiations have continued to reconcile the opposing views ahead of the EU Council’s Employment, Social Policy, Health and Consumer Affairs (EPSCO) meeting which was held in Luxembourg this week.

Stressing the need to find “the right balance between patient freedom, the sustainability of public health systems and the right of the member states to organize their own health systems,” the Council meeting included a public debate on the draft directive. Many delegations called for Article 152 to be included in the legal basis of the directive and for long-term care to be excluded from its scope, proposals which were accepted by the European Commissioner for Health, Androulla Vassiliou. However, she also said that further discussion was needed on prior authorisation and the possible exclusion of some healthcare providers.

A statement issued by the Council after its discussions – which were chaired by Dana Juraskova, health minister of the Czech Republic which currently holds the EU Presidency - stated simply that the first round of negotiations concerning the individual sections of the draft directive were now complete.

“The main provisions of the draft directive stipulate the patients’ right to seek healthcare in another EU member state and to obtain reimbursement of the costs of this care in an amount equal to the amount provided by the country in which they are insured. Patients may gain certainty that the quality and safety standards of the provided healthcare are regularly monitored and based on proven medical procedures,” said the Council.

Czech Health Ministry spokesman Ivo Hartmann added that the directive “should also simplify European cooperation in healthcare with emphasis on recognition of medical prescriptions, development of European reference networks, eHealth and assessment of healthcare technologies.”