Address at the international conference “Cross-border Healthcare”

Bled, 25.10.2012  |  speech

Opening address by Dr Danilo Türk, President of the Republic of Slovenia, at the international conference “Cross-border Healthcare”
Bled, 25 October 2012


Distinguished participants,

The transposition period of 30 months provided for the implementation of the Directive on the application of patients’ rights in cross-border healthcare is coming to an end. There has been ample time for it, and it is now for this “Cross-border Healthcare” conference to answer the numerous questions relating to the Directive with a view to defining in detail its objectives and strategy.

The Directive is an important document that has brought a fundamentally new dimension to an integrated healthcare system within the European Union. It has been designed to establish more uniform regulation of the rights of patients to access healthcare outside their country of residence. Pursuant to the Directive, all member states must adopt measures to facilitate access to a safe, high-quality, efficient and financially stable healthcare system. This opens up a path towards significant change in the ways in which we, European citizens, perceive and use health services: less local and national, more diverse and European.

I would like to reiterate on this occasion that health is one of our core values, and that health does not mean just the absence of disease, but is a state of complete physical, psychological and social well-being. Hence, health is associated with both well-being and social certainty, which are European values we all hold dear.

According to the World Health Organisation's definition, health is to be understood as an integrated and dynamic system capable of adjusting to a changing total environment and enabling individuals and communities to carry out their biological, social and professional functions and preventing disease, vulnerability and early death.

The question now is whether the Directive, which will start to be implemented next year, brings all these different aspects of the understanding of health any closer to us and whether the systems in the member states are organised and operated so as to enable health to be understood as a state of complete physical, psychological and social well-being. Social well-being is, after all, our common European concern.

We are currently facing difficult conditions and rising expenditure on healthcare. There has been a rapid development in the area of healthcare technology, advances in medicine have been made at an incredible pace, some diseases have changed, the population has been ageing, and people have become more aware, better informed and also more demanding when looking for the most appropriates health services, medicinal products and medical devices. From a viewpoint of ensuring appropriate conditions, the state of affairs in the field of medical care has been changing and improving, though in an unbalanced and not always the most appropriate manner.

The introduction of new methods and particularly the development of technologies are seldom in keeping with the financial resources available. For that reason, the implementation of the Directive on the application of patients’ rights in cross-border healthcare also raises the question of how to strike the right balance between financial sustainability and increasing demand for healthcare services.

We will have to primarily decide how to maintain and improve the existing quality level. Here, it should be underlined that we cannot assign this entire task to hospitals: it has to be shared between policy-makers, health funds, governments, health institutions, as well as civil society and, very importantly, citizens themselves, who must also play their part in caring for their health.

The majority of EU member states have to deal with similar problems and tackle almost identical tasks. For all these reasons, we have to perceive the Directive as an opportunity to ascertain some key and fundamental human rights, namely the accessibility of health services and appropriate health treatment. Let us not forget: ever since the code of human rights has been adopted internationally, the right to the highest attainable standard of physical and mental health has been one of the fundamental human rights. What is the highest standard? What is attainable? These are important and difficult questions, which have to be raised and answered. The Directive offers a framework within which answers can be sought.

We can all rely on internationally accepted principles of quality, which define the effectiveness of health treatment, patient safety, timeliness of delivery of healthcare services, performance and treatment equality.

The Directive enables these principles to be implemented within a broad framework; it also provides the basis for a just and efficient healthcare system focused on the citizen, patient and insured person with all the rights pertaining.

There are a number of practical concerns associated with the Directive, however, and it is appropriate for this Conference to voice them as well. As regards the Slovenian healthcare system, the question of how well prepared we are to provide services to the citizens of other European states is of particular importance. Do we perceive this as an opportunity for the development of domestic medicine and an opportunity to provide high-quality medical services on competitive terms to the citizens of other European Union member states and to their various insurance systems? The Directive aims to establish reasonable competition in a wider geographical area. The health institutions which will enjoy broader public trust, in keeping with the principles of increased efficiency and accessibility, will also become more visible and attract more interest. We can also expect competition among insurance companies to evolve. This might involve some traps and risks of stronger differentiation, however, which would reduce accessibility for poorer EU nationals. And accessibility is the first objective of the Directive. It should not be inadvertently diminished in any way.

The system of accreditations, to be obtained by almost all Slovenian hospitals, will lead us closer to the ambition of open health-service provision, but accreditation alone will not be sufficient. Our health institutions can significantly increase their competitiveness by improving their organisation and remuneration systems and through mutual integration, not only within the country but also through participation in the reference networks of hospitals within the EU. This is where medical services become less local but also more difficult to organise. It also implies changes in behaviour of patients who are used to locally provided medical services.

I am hopeful that the Directive will facilitate reasonable integration of European health and insurance systems to result in appropriately oriented medical specialisations and cooperation between health institutions. Without doubt, the Directive also facilitates and promotes cooperation in joint projects, such as Health 2020, the new WHO European policy for health.

The European plan to strengthen public health puts forward two important premises: the prevention of illness and promotion of health and the management of chronic non-communicable diseases. The strategy and action plan for healthy ageing in the European Union will also have to rely on the Directive on the application of patients’ rights in cross-border healthcare, bearing in mind its purpose to promote European cooperation in the area of healthcare and facilitate standardisation of quality in healthcare throughout the European Union.

Distinguished participants,

Allow me to conclude by expressing my gratitude to the Ljubljana University Medical Centre for organising the international conference “Cross-border Healthcare”. The questions that have been posed to the conference participants about the improvement in quality, about the improvement of the conditions for exercising the rights of patients to healthcare, and concerning the issue of our readiness to implement the Directive are the right ones to be asking. I am convinced that the discussion at this conference will bring forward real and meaningful answers.

I am sure that your conference report will be an important contribution to the discussion in the European Union, which has not come very far as yet. Normally, political decision makers are focused on other matters, this time on financial issues and various questions of European integration. But in focusing ourselves on what seems to be the immediate priority, we should not lose sight of something, which is much deeper, much more fundamental and much more relevant to the well-being and the future of European citizens.

Welcome to Slovenia. I wish you every success in your deliberations and I look forward to reading your report. Thank you very much.