EPSU Report "Expansion and consolidation? Major trends and eligibility for European Works Councils" in health care

(Brussels, 18 February 2013) EPSU has published the report "Expansion and consolidation? Major trends and eligibility for European Works Councils" reviewing multinational companies involved in the healthcare sector in 2012 and assessing their eligibility for the setting up of a European Works Council. This is done in the context of European and national policies impacting on health care and the strategies of multinational companies operating in this sector. The study, building on previous papers on the same subject, has been commissioned from PSIRU and written by Jane Lethbridge. The text below mainly builds on quotes from the Executive Summary.
Multinational Companies involved in the healthcare sector in Europe can be divided into five main groups, which are not exclusive:
• Service companies – facilities management
High technology equipment for diagnosis and treatment, e.g. renal care
• Laboratory services – pathology services
• Healthcare companies that provide healthcare directly
• Public-private partnerships
The impact of the economic/financial crisis and austerity policies in many European countries can be seen on several companies. Austerity policies in many European countries have reduced public sector budgets with some reductions of contracting-out but austerity policies can also lead to increased contracting out.
A series of short company profiles include a) companies eligible for EWCs and b) companies not yet eligible for EWCs but which have shown signs of expansion outside their domestic market. {{ {Background information} }}
The paper starts with an overview of EU legislation and the development of public health and healthcare policy at European level. It highlights the role of the European Court of Justice (ECJ) that has influenced health policy through decisions about cross border healthcare as well as medicine and pharmaceuticals. It assesses the impact of the Directive on the application on patients’ rights in trans-border health care (2011/24/EU). A second issue where action at EU level is affecting national healthcare systems is the movement of professionals.
Although national governments retain the responsibility for health care policy, many policies, for example, contracting and outsourcing, adopted by national government have created markets in national healthcare systems. Services delivered by national health systems are, as a rule, now considered as an economic activity, according to ECJ rulings and EC policies of recent years, for which the rules of Community law, on the fundamental freedoms of the internal market, public procurement and state aid in principle, apply. Exemptions, exceptions and limits can and need to be decided by making reference to other policy goals, such as health, social and employment policy, and by invoking ‘overriding reasons of general interest’ or ‘public service obligations’. What often starts with the contracting-out of ancillary services evolves into more extensive contracting-out of diagnostic and clinical services, which are unambiguously healthcare services, leaving reduced core services directly delivered by the public sector
In countries of Central and Eastern Europe the transformation of publicly funded and publicly provided healthcare systems has taken place since 1989. New legislation has created a legal basis for private providers to operate and charge fees. Decentralisation of hospitals and health care institutions has been accompanied by a reduction in health care budgets which have led to the introduction of user fees and subsequent limits to publicly provided or financed healthcare access. User fees have contributed to the corruption at local and national levels. All these changes have contributed to the weakening of public healthcare systems. Although there have been attempts to challenge these reforms and struggles to maintain publicly funded healthcare systems continue, there have been some fundamental changes which make healthcare vulnerable to continued commercialisation.
EPSU Report "Expansion and consolidation? Major trends and eligibility for European Works Councils" in the health care sector (January 2013), written by Jane Lethbridge, PSIRU/University of Greenwich