The lack of formal European competencies can account for Member States’ failure to address the contentious issue of the impact of European integration on health care systems and, in particular, what possible social implications it entails (solidarity, equity, accessibility and quality of care). In any case, pressure from those working in the field (practitioners, administrators and policy makers) and citizens (patients) will make it difficult to keep this issue off the political agenda.

With a view to preparing the political debate, the Belgian Presidency of the EU is organising a scientific conference that aims at:

1. Identifying the possible influences of European integration on Member States’ capacity to organise and finance their health care systems in an autonomous manner. The European Union has already tackled health care issues, mainly through the functioning of the single market rules. The aim is to examine the extent to which such a market-oriented perspective of health care could affect the social aims of the Member States’ health care systems.
   
2. Making recommendations, at national and European levels, that attempt to respond to the challenges of the impact of European integration on health care systems from a social perspective. The recommendations should indicate the first steps to be taken to place social concerns more centre-stage.

Through this conference the Belgian Presidency of the European Union seeks to review the current situation and make it clear that it is no longer the Nation-State alone that decides upon (the organisation and financing of) health care, as it is increasingly influenced by the European level.

However, if health care is currently being examined at European level, it is mostly indirect, through the free movement of persons, services and goods of the internal market, through the competition rules and (pharmaceutical) industrial policy. The Ministers of Social Affairs and Public Health are generally not involved in deciding upon these policies. Moreover, many decisions that have important consequences for health care are taken by the European Court of Justice, based on an interpretation of general rules in the Treaty. They are not subject to any political ratification or control by Member States.

The main question is "how could better structural guarantees be built in at European level to take social concerns into consideration, while pursuing policies to achieve the internal market?"

Alternatively, "how could Europe guarantee a high level of social protection, considering the increasing influence of the internal market on health care?"

This main question contains several sub-questions:

• Can the general rules concerning free movement and free competition be applied to the health care sector and to what extent are specific rules needed? How would it be possible to reconcile the divergent needs of a far-reaching and completed market on the one hand and the preservation of health care systems with definite social aims on the other?
  
• What future awaits Member States’ health care systems without any corrective action by the (European) authorities and what possible risks could be related to this inaction? Should the authorities have additional instruments at their disposal to adjust the market?
  
• What new initiatives could the European market create to make health care more efficient?
  
• Which forms of co-operation are practical at bilateral level (e.g. simplification of procedures for cross-border health care) and at European level (e.g. a minimum compulsory insurance package, referral patterns and procedures, prescription requirements, recognition of services and health care providers and procedures for assessment of cost effectiveness)?
  
• How should this co-operation be established: via informal co-operation, arrangements and recommendations, commonly agreed aims, indicators, the exchange of experience and assessment mechanisms, guidelines, or European-level legislation?
  
• How should the responsibilities of the Member States and the Union be determined?