The Free Movement of Health Professionals

1

Institute of Medical Sociology
Johann Wolfgang Goethe-University, Frankfurt
Thomas Gerlinger

• The Free Movement of Health Professionals
• Fórum Mercosul
• Rio de Janeiro, March 22th 2006

2
Contents

• The European Union and the Health Care Sector
• Legal Provisions on the Free mMovement of Health
  Professionals
• Extent of Transnational Migration of Health
  Professionals
• The Draft Services Directive
• Conclusions

3
The European Union

• 25 member states
• 460 million people
• common market free movement of
• goods
• capital
• Persons
• services
• predominance of economic integration
• lack of corresponding political competencies at
  the European level (esp. social policy)

4
EUs Main Obligations in Health Policy

• direct attention to improving the health of the
  population
• ensure a high level of health protection in all
  fields of Community policy

5
EUs Main Competencies in Health Policy

• subsidiary role
• promote cooperation
• complement national policies
• explicit regulatory authority
• health and safety at work
• consumer protection

6
Nation-States Main Competenciesin Health Policy

• type and extent of coverage in case of illness
• organization of services
• institutional structures
• division of labour
• mode of regulation of the health care system

7
Legal Provisions on Recognition of Certificates
(1/3)

• sectoral directives
• educational requirements
• provisions for admission
• duration of training
• scope of training
• minimum standards

8
Legal Provisions on Recognition of Certificates
(2/3)

• general directives
• assumption uniformity of qualifications in the
  member states
• no harmonization of qualifications

9
Physicians Directive (3/3)

• automatic recognition
• citizenship of a member state
• diploma is aquired in one of the member states
• training in one of 52 listed specializations

10
Transnational Migration of Health Professionals
(1/2)

• differences in income level
• differences in workung conditions
• working hours
• work load
• Dissatisfaction among health professionals

11
Transnational Migration of Health Professionals
(2/2)

• increase of migration
• but no massive migration (brain drain)
• mostly from poorer to richer countries

12
Barriers

• language problems
• restricted admission by some member states

13
German Example (2003)

• 340 000 doctors
• 11 800 from abroad (4 )
• 5 200 from EU countries (1,8 )
• 2 500 from newly admitted east European member
  states (0,8 )
• 1 300 office-base (self-employed) doctors (1,0
  of office-based doctors)
• Nurses 7,7 from abroad

14
EUs Competencies in Health Policy

• subsidiary role
• promote cooperation
• complement national policies
• explicit regulatory authority
• health and safety at work
• consumer protection

15
Draft Services Directive

• prohibition of arbitrary requirements for
• establishing services
• delivering services
• from abroad within the EU
• country of origin pinciple

16
Draft Services Directive Effects

• loss of control by the target country
• loss of quality in care
• social dumping
• working conditions
• salaries

17
Conclusions

• free movement of health profssionals
• system of mutual recognition of certificates
• increase of transnational migration
• rut remaining low in quantity
• divergent interests of employees in the European
  Union
• binding regulations of social standards needed
• better cooperation on European level