Health policy at European level
Under the Treaty on the Functioning of the European Union (TFEU), responsibility for the organisation and delivery of health services and medical care rests with the Member States (Article 168 TFEU). In fact, the European Parliament and the Council are expressly prohibited from taking steps to harmonise the relevant laws and regulations of the Member States (Article 168 (5) TFEU). Nonetheless, the European Union does have scope to take action in the sphere of public health. This is the result, firstly, of the competences set out in the TFEU, which primarily relate to the improvement of public health and prevention of illness and diseases, and include, in particular, action to obviate sources of danger to human health, the fight against the major health scourges, and complementary action to reduce drugs-related health damage. Article 168 TFEU also assigns the EU responsibility for setting high standards of quality and safety of organs and substances of human origin, blood and blood derivatives.
Secondly, provisions relating to the common market in the European Union, and in particular the four fundamental freedoms enshrined in the TFEU – the free movement of goods (Articles 28-35 TFEU), persons (Articles 45 and 49 TFEU), services (Article 56 TFEU) and capital (Article 64 TFEU) are having a growing impact on national health systems. The European Court of Justice (ECJ) has made it clear in several rulings that these fundamental freedoms also apply in the sphere of public health. In 1998, the Court ruled that medical products and services are subject to the free movement of goods and services. The pharmaceuticals market, for example, is almost fully harmonised throughout the EU as a result. The ECJ also ruled in 2001 that patients resident in one Member State can obtain hospital treatment in another under the freedom to provide services.
The German legislature drew the appropriate conclusions from the ECJ rulings and applied this interpretation of the law to the German health system with the Statutory Health Insurance Modernisation Act (GKV-Modernisierungsgesetz), which entered into force in 2003. Regarding the transposition of European law into national legislation, it is a recurring bone of contention within the Committee whether to adhere closely to European provisions and recommendations or require a higher level of protection. The Committee members request regular briefings from the Federal Government about the plans of the European Parliament and the European Commission. Before and after the meetings of the EU’s Employment, Social Policy, Health and Consumer Affairs Council (EPSCO), the Federal Government briefs the Committee about current developments at European level.
The EU documents referred to the Committee by the plenary are at the centre of its deliberations on European health policy. In the 17th electoral term (2009-2013), for example, the Committee looked in detail at European anti-drugs policy. Both the EU Drugs Strategy (2013 – 2020) and the Communication from the Commission to the European Parliament and the Council entitled "Towards a stronger European response to drugs" were the subject of vigorous debate at an expert consultation, attended by a representative, with responsibility for criminal justice, of the European Commission’s Directorate-General for Justice, and other experts.
Another important topic for the Committee was the "Proposal for a Regulation of the European Parliament and of the Council on clinical trials on medicinal products for human use, and repealing Directive 2001/20/EC". The Committee requested several briefings from the Federal Government about the progress of this proposal. Both the Committee and the Federal Government found it problematic that the EU proposal only gave patients the right to object instead of requiring their informed consent, and that it watered down the protection for emergency patients incapable of giving consent.
The modernisation of the Professional Qualifications Directive was also discussed in depth by the Committee on Health, which rejected the proposed provisions on training for nurses and midwives. The concerns expressed by the Committee were ultimately reflected in a motion for a resolution, which stressed that the admission requirements for entry to nursing and midwifery training should continue to be ten years of general education rather than being raised to twelve years. The new text of the Directive adopted in the summer of 2013 now provides for two equal admission routes. As a result, German nursing qualifications will continue to be automatically recognised throughout Europe.