Legal Consequences of EU Accession for Central and Eastern European Health Care Systems

• Date: 01 December 2002
• Author: A. P. Den Exter
• DOI: http://doi.org/10.1111/1468-0386.00165
• Published date: 01 December 2002

Legal Consequences of EU Accession

for Central and Eastern European

Health Care Systems

A. P. den Exter*

Abstract: Since the rati®cation of the Europe agreements, Eastern European accession

countries are transposing community law into their national legal framework. The law

approximation process in the ®eld of health concerns three themes, viz public health,

health-related issues, and the internal market. Although the health acquis has been

largely focused on public-health issues, it is increasingly becoming clear that internal

market treaty provisions may also aect health-related rights. For candidate member

states this means that the common market has important consequences for health and

their health-care systems. Therefore, this paper will examine the impact of relevant treaty

provisions on acceding countries' (public) health legal framework.

I Introduction

In the aftermath of Communism, the legal systems in Central and Eastern Europe

(CEE) have experienced major changes. Besides the internal impetus, the transforma-

tion towards a `western' democracy that respects fundamental economic and legal

principles has been strongly stimulated by the European Union and its Member States.

A major landmark in this reform process was the rati®cation of the Europe Agree-

ments, which constitute the central legal pillar towards future accession. On the basis

of this document, most applicant countries have de®ned their own priorities for

accession, notably those concerning the `internal market'.

Less known are the consequences of accession to the ®eld of health. Therefore, this

paper discusses possible implications to applicants' (public) health legal framework.

Analysis of relevant EU policies reveal the consequences to public health and health-

related legislation. Even more interesting is the relevance of the `internal market' to

national health-care systems. It will be argued that transposing EC Internal Market

provisions will impose considerable regulatory changes on health-care systems.

II Historical Background

In recent years, the relationship between the European Union and Central and Eastern

European countries has changed dramatically. As early as 1990, the EU had launched

a programme for concluding far-reaching collaboration with Central and Eastern

European Law Journal, Vol. 8, No. 4, December 2002, pp. 556±573.

#Blackwell Publishers Ltd. 2002, 108 Cowley Road, Oxford OX4 1JF, UK

and 350 Main Street, Malden, MA 02148, USA

* Erasmus University Rotterdam, European centre for advanced legal studies in health care, the Nether-

lands. Correspondence: E-mail denexter@bmg.eur.nl

Europe. As a result, in mid-1991 the ®rst so-called Europe Agreements were signed by

several signatories.

1

These `®rst generation' Europe Agreements (EA) established an

association between the European Communities and their Member States, of the one

part, and the individual candidate states on the other part.

2

It was only at the Copenhagen European Council (1993) that the EU Member

agreed on the possibility for Eastern EA-partners to join the EU, and formulated

criteria for membership, which are often referred as the `Copenhagen criteria'.

3

These

criteria were subsequently incorporated in the concluded Europe Agreements. This

new approach of the Europe Agreements requires that candidate countries approx-

imate their legislation to that of the European Union, particularly in the areas relevant

to the Internal Market. The `approximation of law'-strategy is considered as a crucial

condition for future accession. This includes, inter alia, applying legislation favouring

competition, which is compatible with comparable legislation in the EU.

4

But also

public health has been recognised as part and parcel of the approximation-strategy.

In sum, the bilateral Europe Agreements constitute the ®rst binding legal document

recently aimed at accessing the European Union by means of a common strategy, viz,

approximation of current and future legislation.

III Impact of EU Accession to National Health Legislation

Accessing the EU will impose candidate countries to approximate national legislation

to EC law. In the ®eld of health, transforming EC law concerns three themes, viz,

public health, health-related issues, and the `internal market', i.e. the free movement

principles and competition.

A Public Health

The Europe Agreements set approximations of public health legal standards as one of

the adjustment priorities of the EU accession preparations.

5

According to the EC

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December 2002 EU Accession and Central/Eastern European Health Care

1

E.g., Hungary: OJ 1993 No. L 347, 31/12/1993 at 2, Poland: OJ 1993 No. L 348, 31/12/1993 at 2; Due to

the dissolution of former Czechoslovakia, renegotiations with the separated states were necessary and

resulted in separate agreements: the Czech Republic: OJ 1994 No. L 360, 31/12/1994 at 2 and the Slovak

Republic: OJ 1994 No. L 359, 31/12/1994 at 2.

2

To overcome possible delay due the long period of rati®cation, the EC concluded so-called `Interim

Agreements' which should overlap the period the Europe Agreements came into force. M. Maresceau,

E. Montaguti. `The relations between the European Union and Central and Eastern Europe: A legal

appraisal', (1995) 32 CMLR at 1329.

3

Membership requires that the candidate country has achieved: stability of institutions guaranteeing

democracy, the rule of law, human rights, and respect for the protection of minorities; the existence of a

functioning market economy as well as the capacity to cope with competitive pressure and market forces

within the Union; the ability to take on the obligations of membership including adherence to the aims of

political, economic, and monetary union (Copenhagen European Council, 1993). In addition the

Copenhagen Summit, the Essen European Council (1994) re®ned the pre-accession strategy to prepare

the partner countries for EU membership. The Nice Treaty (Nice Summit, 2000) marked a new stage in

the preparations of EU enlargement. OJ 2001 No. C 80 10/3/2001, at 1.

4

E.g., EA Hungary, article 68. Other areas of approximation concern: customs law, company law, banking

law, company accounts and taxes, intellectual property, protection of workers at the workplace, ®nancial

services, rules on competition, protection of health and life of humans, animals and plants, food

legislation, consumer protection including product liability, indirect taxation, technical rules and

standards, transport and the environment

5

EA Hungary, Article 68, mutatis mutandis EA Czech Republic and EA Poland.