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European Union enlargement and health policy
Edited by Josep Figueras, Martin McKee, Laura MacLehose and Ellen Nolte
European Observatory on Health Systems and Policies Series - 2004

Available online as PDF file [314p.] at:
http://www.who.dk/document/E82999.pdf


Press release:  "......The first analysis to address the consequences of
European Union (EU) enlargement for health sectors in both new and
existing member states has been published. The book, Health policy and
European Union enlargement, was written by leading health policy experts
from 20 countries, brought together by the European Observatory on
Health Systems and Policies, a partnership of 12 organizations,
including the WHO Regional Office for Europe.

 

The study is an attempt to ensure that the cause of health is not
overlooked on this momentous occasion for Europe. It examines and
quantifies costs and risks arising from new members joining the EU, and
aims to help governments formulate strategies for public health.

 

The study highlights how enlargement brings both opportunities and
challenges. Patients from the new member states will be able to obtain
some health care services throughout the EU. Health professionals will
be free to travel, with some seeking more lucrative jobs in the
wealthier member states. There will be new regulatory regimes, and
health care managers will have to comply with an extensive body of
legislation on issues such as working time, health and safety, and data
protection. Free-trade policies will have to be balanced with public
health considerations, particularly with regard to substances that are
legally traded but potentially hazardous, such as tobacco and alcohol.
The new borders of the EU enclose large vulnerable populations, such as
elderly people and minority groups, and it will be important to ensure
that they do not fall behind. All these and many other issues will have
implications for health care systems.

 

The Observatory study cautions that the effects of the changes that come
with accession are extremely difficult to predict, and systems should be
put in place to monitor the effects of this process, to maximize the
benefits and minimize the potential hazards. "For many of the new member
states, their health systems are emerging from a period of tough
transition. Yet joining the European Union can bring substantial new
challenges," notes Dr Marc Danzon, WHO Regional Director for Europe.
"Our mission is to support these countries, providing the help they have
come to expect from us."

 

During the past decade, the new member states of the EU have made
tremendous progress in improving health status and the quality of their
health systems, but, as the study shows, they also have a major
unfinished agenda for health system reforms. One of the biggest
challenges of the transition was the need to implement the existing body
of EU law: the acquis communautaire. In many respects, the process of
negotiating the adoption of these laws has not been kind to the health
systems of the countries. They "have experienced something of an
investment famine in the health sector," says Stephen Wright, Division
Chief, Human Capital Projects Directorate, European Investment Bank.
"It's both a threat and an opportunity: a threat because health care
systems have suffered through the transition, with consequences for
population health, and an opportunity to rebuild these systems by
learning from world experience," he adds. Armin Fidler, Health Sector
Manager at the World Bank, says, "Despite having achieved great
successes in developing sustainable health financing, the countries of
central and eastern Europe will have to continue their reforms in the
health sector to cope with the new EU environment." Both the European
Investment Bank and the World Bank have co-sponsored the study.

 

The implications of enlargement do not halt at the new borders, the
study stresses. With the first wave of enlargement just completed and
the second expected around 2008, it is important to address the health
concerns of the countries that have yet to join the accession process.
"Much work still needs to be done in south-eastern Europe to catch up
with European Union standards. This will require coordinated strategies
linking the health and social sectors, education and free media and
civil society," says Roxana Bonnell, of the Open Society Institute, also
involved in the study....."



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