The privatisation of public health services is gradually spreading across Europe. EU member states’ health systems are split between employment-related health insurance and those financed through general taxation.
Recent rulings from the European Court of Justice, and the European Commission’s policies of recent years, mean that:
“Services delivered by national health systems are, as a rule, now considered as an economic activity”.
Healthcare is being subjected to political and policy pressures, including from the EU-level, and this has created conditions that allow a growing role of private healthcare companies in this traditionally public service.
These companies naturally want to secure profits for shareholders out of these health services and that risks deteriorating conditions for staff like reduced pay and staff levels, greater workloads and stress, all of which negatively impact on safety and quality of care.
Greater health inequality is fostered as private, for-profit providers ‘cherry-pick’ lower-risk and paying patients, whilst higher-risk and poorer patients, or those needing emergency care, remain reliant on under-resourced public health services.
There is clear evidence of lobbying by big business groups, companies and think tanks from private hospitals, private health insurance and others. This helps feed the financial and political agenda that encourages more privatised models of healthcare.
This article explores the EU policy areas – and the role of corporate lobbying – that help create this pro-privatisation orientation in the field of healthcare: marketisation, trade, public private partnerships, and economic governance.
Finland is facing a major healthcare reform called “SOTE”. We are told that our healthcare is a national competence, not the remit of the EU, and that the EU has no right to interfere in our public healthcare system. Some MP’s in Finland have called for a review of the SOTE reform by the EU but this has been rejected by the government because they fear delays, but could there be other reasons?
Almost nothing has been explained or written by the government or by the media on this and Finnish European Members of Parliament have remained silent on this matter.
There are reasons to be concerned about this situation because there is a very realistic threat that parts of this SOTE reform could actually lead to the EU declaring that the “newly reformed” Finnish public healthcare system is an economic activity!
Recent rulings from the European Court of Justice, and the European Commission’s policies of recent years, mean that “Services delivered by national health systems are, as a rule, now considered as an economic activity”.
Member states have argued that public healthcare is not an economic activity, as most providers do not intend to make a profit. However, treating this as an economic activity means that EU rules on the internal market – the free movement of goods, persons, capital and services, public procurement and state aid, in principle apply to healthcare services.
The EU Commission’s 2011 directive on cross-border health care, partially based on internal market rules promised to expand the choice of patients in Europe.
More fundamentally, it answers the question of whether healthcare should be publicly planned or subject to market forces. It also opens the door to countries’ exporting their healthcare problems, e.g. richer member states sending patients to poorer ones where treatments are cheaper, potentially depriving locals of medical resources that instead go to well-paying foreign patients – a problematic kind of ‘medical tourism’.
There is also an inbuilt inequality around whose choices are increased: patients likely to leave their country for treatment will mainly be those able and accustomed to travel or live abroad, in other words those with higher incomes. Whilst “the choices of those who are not mobile, for language and cultural reasons, and who are dependent on neighbourhood support, may actually shrink as a result of local services becoming increasingly under-funded” ie those on lower incomes.
The big consulting companies, who claim to be independent consultants (KPMG, Price Waterhouse Coopers (PwC) and McKinsey, etc.) – have all been pushing hard for privatising public healthcare in many EU countries. They are certainly not independent consultants in any sense of the word. They lobby hard for the interests of private operators who are paying them important consulting fees for their services as advisors to PPP projects.
Many of the elements of the SOTE reform, like the proposed “freedom of choice” and “for profit firms” as suppliers of healthcare services are precisely what the EU is looking at when deciding whether there is an economic activity.
The SOTE reform can thus be regarded as a Trojan Horse that allows the EU to intervene in out national healthcare system with a results that favours healthcare diversity for high income residents to the detriment of reduced healthcare availability for low income folk in Finland.
Is that what we are voting for? It is doubtful that most voters understand what they are signing up for…
There are 2 excellent articles on this subject in the 2 links here below: