Health Care Reform Workshop Ukraine 16 and 17 May 2017 Kyiv Ukrainian Health Trade Unions; ITUC; PERC; ILO; EPSUX X Relevant EU norms and regulations

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1 Health Care Reform Workshop Ukraine 16 and 17 May 2017 Kyiv Ukrainian Health Trade Unions; ITUC; PERC; ILO; EPSUX X Relevant EU norms and regulations in the context of the Association Agreement Ukraine-European Union (UA-EU) X Mathias MAUCHER, Policy Officer Health and Social Services, EPSU

2 Structure of Presentation EU-UA Deep & Comprehensive Free Trade Area (DCFTA) o Chapter 4: Sanitary & phytosanitary (SPS) measures o Chapter 6: Freedom of establishment in services o [Chapter 6: Health care no sector under process of legislative approximation once UA will have adopted related EU acquis] o Chapter 8: Public procurement o Chapter 10: Competition & state aid rules EU norms and regulations in/applicable to health care o EU law: 1) EU Treaty provisions => values & principles; 2) Health-related EU legislation & regulation ; 3) Other EU leg. & reg. impacting on health care systems/services/workforce o EU policy: 1) European Council; 2) European Commission o Topics: 1) Services of general interest (SGI); 2) European Semester/Economic Governance (EEG); Long-term care (LTC) Healthcare Reform in UA: Problems & Open Questions o E.g. reduction of employment in public sector; new financing mechanisms; pooling of resources at level of regional hospital districts; family doctors; understaffing; non-paid wages/special benefits; non-application of existing legislation/regulations; noncompliance with procedures of decision making/consultation, including based on social dialogue; lack of good governance

3 Association Agreement UA-EU Values & principles o Areas covered i.a. social development and protection o E.g. good governance; democracy; rule of law; respect for human rights and fundamental freedoms; market economy; sustainable development Enhanced cooperation in 28 key sector policy areas o Employment, social policy and public health covered o Tools: Process of gradual approximation with EU acquis and where relevant with international norms and standards (e.g. ILO Conventions, including on core labour standards) o Chapter 21: Employment, Social Policy & Equal Opportunities o Chapter 22: Public Health: 1) Strengthening of public health system & capacity (i.a. development of primary health care; training of staff); 2) Prevention & control of communicable & non-communicable diseases; 3) health in all policies approach o Annexes XL (Chapter 21) & XLI (Chapter 22) => EU legislation EU-UA Deep & Comprehensive Free Trade Area (DCFTA) o Binding provisions on gradual approximation with EU norms and standards in trade and trade-related areas o Fields relevant for health care systems/services/workforce covered => Next slide

4 Association Agreement UA-EU Chapter 21: Enhanced cooperation on Employment, Social Policy and Equal Opportunities o Selection of pieces of EU legislation listed in Annex XL: Labour law: fixed-term work; part-time work; employees rights in the event of transfers of undertakings; general framework for I&C; general framework for equal treatment in employment and occupation; parental leave Health and safety at work: framework directive & several other directives, including on protective equipment at workplace, carcinogens & mutagens, biological agents, electromagnetic fields, manual handling of loads, WTD o Timetable: Implementation of provisions in Ukrainian legislation within 3 or 4 years after entry into force of AA (non-political chapters signed: 27 June 2014; ratification in NL pending) Chapter 22: Enhanced cooperation on Public Health o Selection of pieces of EU legislation or of documents from the European Council (= recommendations) listed in Annex XLI: Communicable diseases; Blood; Tissue, Cells and Organs; Prevention and reduction of health-related harm associated with drug dependence; Cancer screening; Tobacco; Alcohol o Timetable: As above; sometimes no legislative initiative needed

5 EPSU priorities for public services / Key principles for services of general interest Public services at the heart of Europe Solidarity Universality Continuity Equal access Affordability User rights Concertation Democratic control Sharing of costs and risks between people, regions Access to services irrespective of status Investment, maintenance of service No discrimination, proximity Reasonable prices (social / progressive tariffs, limits on profits..) Information, redress Social dialogue, user groups Transparency, monitoring, regulation, evaluation

6 EU-UA Deep Free Comprehensive Trade Area Chapter 4: Sanitary & phytosanitary (SPS) measures o Target group in health sector => Veterinarians o Aim: Facilitation in SPS-related good o Tool: Align legislation of UA to relevant EU legislation & Conclude a veterinary & phytosanitary chapter Chapter 6: Freedom of establishment in service o Target group in health sector => All health professionals o Aim: Integration of UA to maximum into the internal market o Tools: 1) Freedom of establishment in services ( ) sectors, with limited reservations identified in a negative list (= what not listed is not excluded); 2) Process of legislative approximation Chapter 8: Public procurement o Target group in health sector => Whole workforce/all services o Aim/Tool: Adoption of current and future EU legislation Chapter 10: Competition & State aid rules o Target group in health sector => Whole workforce/all services o Aim: Enforcement of anti-competitive practices (e.g. cartels; dominant position; anti-competitive mergers) o Tool: Application of state aid rules to all liberalised areas in DCFTA & to all state-controlled enterprises

7 EU-UA Deep Free Comprehensive Trade Area Chapter 13: Trade and sustainable development o Target group in health sector => Whole workforce/all services o Aim: Confirmation of shared commitment to application of and compliance with ILO Core Labour Standards & to promotion of ILO Decent Work Agenda o Tool: Use of ILO Core Labour Standards & of ILO Decent Work Agenda o Safeguards: 1) Confirmation of right to regulate by governments/different levels of public administration in areas affected by DCFTA when pursuing policies that have the objective to establish high levels of environmental and labour (rights) protection; 2) Commitment to refrain from social dumping /race to the bottom initiatives by waiving or derogating from environmental and labour (law) standards; 3) Setting up of strong monitoring mechanism, building on public scrutiny through the involvement of civil society organisations [=> in EU logic CSO can include trade unions and it covers in all cases, e.g. advocacy or users /patients rights organisations]

8 Key EPSU demands on trade policy/ free trade agreements (CETA; TTIP; TiSA) No liberalisation of public services: public services need to be excluded from the scope of trade agreements Social and environmental standards: employment protection, collective agreements, consumer and public health protection, financial market regulation as well as data protection, net neutrality and other digital rights need to be safeguarded (and developed)! Transparency: documents relating to trade negotiations, must be made public; no negative listing, rather positive lists A democratic process: public scrutiny and assessment of the negotiation texts is needed, Parliaments, civil society organisations, trade unions and social partners need to be involved No regulatory cooperation council: regulation must be in the hands of democratically controlled bodies and processes. No ISDS: Investor State Dispute Settlement (ISDS) mechanisms must be rejected

9 EU norms and regulations in/applicable to health care: EU law EU Treaty provisions => values & principles o Art. 3 TEU; Art. 9 TFEU; Art. 14 TFEU & Protocol (No. 26) on Services of General Interest; Art. 153 TFEU; Art. 168 TFEU o Charter of Fundamental Rights of the EU => Art. 25, 26; Art 31; Art. 34, 35, 36 Health-related EU legislation & regulation o Public health => Tobacco control; Blood, tissues, cells & organs; Epidemiological surveillance and control of communicable diseases: Vaccination; Antimicrobial Resistance (AMR) Other EU legislation & regulation o Health and Safety at the Workplace => SSDC HS o Directive 2014/24/EC on public procurement => Best Price- Quality Ratio (BPQR)/most economically advantageous tender (MEAT) instead of the lowest price or lowest cost; promotion of different facets of service quality; compliance with labour law & collective agreements o Directive 2013/55/EU on recognition of professional qualifications o Directive 2011/24/EU on the application of patients rights in cross-border healthcare

10 EPSU s campaign on the 2014 Public Procurement Directives In-house provision and public-public cooperation as a valid choices, alongside public procurement procedures MEAT - most advantageous, not lowest price offer main basis for contract criteria Obligation to respect labour law and collective agreements Transparency in supply-chain obligation to provide details of sub-contractors Clear basis to include social and environmental criteria including regarding the organisation, qualification, and experience of staff and characteristics of process and production methods Respect for fundamental values / principles / specific characteristics of social services and their users

11 EU norms and regulations in/applicable to health care: EU policies EPSCO Council conclusions o Common values and principles in EU health systems o Investing in Europe's health workforce of tomorrow: Scope for innovation and collaboration o Towards modern, responsive and sustainable health systems o Economic crisis and healthcare European Commission o Establishing a European Pillar of Social Rights => Health and Safety at the Work; Social protection; Health care o Effective, Accessible & Resilient Health Systems o Social Investment Package (2013) => Investing in Health o DG SANCO Study Review & Mapping of Continuous Professional Development (CPD) and Lifelong Learning (LLL) for health professionals in the EU (2015) o DG SANCO Study Recruitment and Retention of the Health Workforce in Europe (2015) o Health in all policies approach (2014) o SPC Report Adequate Social Protection for Longterm care needs

12 o Communication Effective, Accessible & o Resilient Health Systems o Strengthen effectiveness: health systems' ability to produce positive health outcomes, i.e. to improve the health of the population o Increase accessibility: capacity of the system to reach the population, without excluding part of it from receiving healthcare services => Multidimensional phenomenon o o Improve resilience: ability to adapt effectively to changing environments, tackling significant challenges with limited resources => Resilience factors

13 European Economic Governance Country-specific recommendations in HSS Sources for country-specific recommendations (CSR) o Country reports elaborated by European Commission services o Joint Economic Policy Committee/European Commission: Report on Health Systems, o ECOFIN: Joint Report on Health Care and Long-Term Care Systems & Fiscal Sustainability. European Economy. Institutional Papers 37, October 2016 o Links to/overlaps with IMF guidance? Non-existence of binding/enforceable EU-level health care (or social) services norms/standards o Examples Pension/retirement age Number of child-places for children aged 0-3; 3-6 Save & effective staffing levels o Character Guidance for benchmarking/political efforts by governments Non-binding policy recommendations, however, need to do national report & consultation and to react to CSR

14 Types of SESL systems (by level of enforceability) AUS: Victoria Legislation with enforceability USA: California? Germany 2018?? Enterprise agreement with enforceability Legislation without enforceability Enterprise agreement without enforceability UK: Wales Czech Republic NZL Guideline UK: England Professional Consensus Customary Practice Norway? Jane Lawless, UNISON, Cardiff, March 2016