Current European and International Issues

The European Working Time Directive is currently under review by the European Commission. The Second Phase of consultation with the social partners has begun. The third round will identify what the review will primarily focus on. The IMO will continue working with the European Medical Organisations to contribute to the review process.

UPDATE: April 2011
After the last phase of consultation on the EWTD, the next phase that is set to take place is negotiations between the trade unions and employers’ groups to try and agree on how to amend the Directive. The two groups have indicated that they wish to participate in negotiations. For these negotiations to begin, the social partners must send a joint letter to the Commission outlining the commencement of negotiations which begins a nine month time limit for the discussions, with the possibility to extend the timeframe. However, the Commission can issue draft amendments to the directive at any stage, but of course would rather the social partners achieve a level of agreement.

The IMO will continue to monitor developments on this issue.

For more information on the European Working Time Directive:
http://ec.europa.eu/social/main.jsp?catId=706&langId=en&intPageId=205

The Commission has launched the review of the Professional Qualifications Directive, which will look at a diverse range of issues within the current Directive.

The Commission has identified three challenges that they wish to focus on as part of this directive:

• Simplification for individual citizens: to facilitate the movement of qualified citizens quicker and easier in order to fill labour shortages throughout the EU.
• Integrating professions into the Single Market: By using innovative tools such as the use of professional cards and common platforms to make the checking of qualifications easier, and the temporary movement of professionals much less arduous.
• Injecting confidence in to the system: As the EU continues to grow, and educational reforms such as the Bologna process are undertaken and regulation of professions in countries is unique, confidence in recognising qualifications is paramount to the success of this Directive. Particularly important, especially for the Medical Profession, is the recording of sanctions or professional misconduct against individuals and how this is communicated between states.

The IMO has actively contributed to the first round of consultation with input provided to our European representative bodies.

UPDATE OCTOBER 2011

The Commission published a Green Paper on the Recognition of Professional Qualifications in June 2011.  The IMO developed a comprehensive response to the Green Paper, which you can view on this page.

The Commission asked for feedback on proposals in the Green Paper under the key areas of:

• New approaches to mobility (such as the introduction of a Professional Card)
• Building on Achievements (addressing issues such as access to information for professionals wishing to move; alert mechanisms for competent authorities, language testing etc)
• Modernising automatic recognition (training requirements such as duration and content and addressing specific issues such as the PQD and medical specialists

The IMO also contributed to the individual responses by the European Medical Organisations, including CPME, UEMS, UEMO and the EJD. 

For more information, or to view the complete Green Paper on the Modernisation of the Professional Qualifications Directive:
http://ec.europa.eu/internal_market/consultations/2011/professional_qualifications_directive_en.htm 

After failing to reach political agreement on a plan for patients to access cross-border healthcare late 2009, the Spanish Presidency earlier this year drafted plans to reach a compromise amongst EU health ministers.

On 8 June 2010 the Council in charge of Employment, Social Policy, Health and Consumer Affairs met in Luxembourg and agreed on the compromise proposal of the Spanish Presidency on the draft directive of the application of patients’ rights in cross-border healthcare.

In September, the Council adopted the first-reading position on the draft directive of the application of patients’ rights in cross-border healthcare.

From these two significant milestones, the Directive began taking shape. The European Parliament’s public health committee met in October, with 227 amendments to the plan, with three major focal points being:

• Patients do not require prior authorization to seek medical care in another country, however if the care requires overnight hospital stays or specialized care, their national system may require prior authorization.
• Member states could only refuse authorization in certain stated circumstances.
• Patients with rare diseases would be covered under the directive.

In December 2010, the Parliament, Council and Commission met to discuss certain issues that still pose problems between the three parties, particularly in regards to the technology required for the successful implementation of the Directive, such as the interoperability of eHealth initiatives and ‘appropriate’ consultations for health technology assessment.

The European Parliament voted on the 19th January 2011 to accept the Cross-border Health Care Directive. After much discussion and negotiation, agreement has been reached on the proposal which is expected to be formally adopted in February, and effective in 2013.

The most obvious beneficiaries will be patients seeking advanced treatments, those living along borders where the nearest hospital is across the line, or those who work in one country but want to get treatment near family members in another country.

• Patients will only be reimbursed at home-country rates.
• If patients require a hospital stay or if treatment is very expensive, they will require prior authorisation from their current national health system. In specific and serious cases relating to the quality or safety of the care provided abroad, patients will be required to seek prior authorisation.
• National health authorities can refuse authorisation if the treatment in question, or the healthcare provider in question, could present a risk for the patient. Also, if appropriate healthcare can be provided at home in good time, authorisation can be refused but Member States will need to explain why such a decision is necessary.
• A request can only be refused if the treatment could quickly be obtained in the patent’s current country, or if there are doubts about the qualifications of the physician.
• Each country must establish at least one national contact point for patients to get information about health providers, reimbursement procedures and when prior authorisation is needed.
• Centres of expertise on rare diseases across the EU will cooperate together.
• The country of origin will ensure that the healthcare provider in the country of treatment can have access to the patient's written or electronic medical records, in conformity with the Directives on data protection. Enhanced cooperation on eHealth between Member States will ensure that this data is fully readable and understandable.
• Several measures are foreseen to ensure continuity of care. The country of treatment will ensure that patients have access to their written or electronic medical records related to the treatment they received. The home country will ensure the medical follow-up is of the same quality regardless of where in the EU the treatment took place.
• A prescription issued in another EU country will be recognised in a patient's country of residence and vice versa. The patient is entitled to obtain the prescribed medicine provided that the medicine in question is authorised for sale and available in the country where he or she wishes to have the product dispensed.
• For non-hospital care, patients will be able to seek healthcare abroad without prior authorisation or formalities, and claim reimbursement upon their return home. This Directive covers not only public, but also private providers.
• The network of national authorities or bodies responsible for health technology assessment will lead to a permanent EU structure of cooperation in this field. The purpose of the cooperation on HTA is to provide objective and reliable information on the efficacy and effectiveness of health technologies.

National governments have 30 months to integrate these measures into national legislation.

For more information:

http://ec.europa.eu/health-eu/care_for_me/mobility_in_europe/index_en.htm