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HEALTH
CARE LAW FROM A COMPARATIVE AND EUROPEAN PERSPECTIVE
July 10-21,
2000
organised
in co-operation with:
- Central European University,
Budapest, Hungary
- Catholic University
Nijmegem, The Netherlands
- Erasmus University
Rotterdam, The Netherlands
- Zorgverzekeraars Nederland
- Nordic School of Public
Health, Gothenburg, Sweden
- University of Glasgow,
Glasgow, United Kingdom
Course Directors:
Judit Sándor (Central European University, Hungary)
André den Exter (Erasmus University Rotterdam, the Netherlands)
Resource Persons:
Judit Sándor (Central European University, Budapest, Hungary)
Monica Bos (Zorgverzekeraars Nederland)
Werner Brouwer (Erasmus University Rotterdam, the Netherlands)
Martin Buijsen (Erasmus University Rotterdam, the Netherlands)
Sarah Elliston (University of Glasgow, United Kingdom)
André den Exter (Erasmus University Rotterdam, the Netherlands)
Lars Fallberg (Nordic School of Public Health,
Gothenburg, Sweden)
Henk ten Have, (Catholic University Nijmegen, the Netherlands),
Ernst Hulst (Erasmus University Rotterdam, the Netherlands)
Judit Sándor
Hungarian medical
lawyer, currently teaching graduate students from Central Eastern European
countries. She worked as a health care lawyer, participated as an expert
in health legislation and launched a patients' rights advocacy
program in Hungary. Published 3 books ( including one edited book)
and 38 articles in the field of human rights and medical law. Received
a JD in Budapest, an LLM degree on comparative constitutional law
and in 1996 Ph.D. on political science and law. Ms. Sandor teaches
medical law, health care law, human rights, legal policy and medical ethics
in different faculties in Budapest. Research fields: medical liability,
reproductive rights, genetics, anti-discrimination laws
Monica Bos
At the moment Monica Bos
works for the Vereniging van Nederlandse Zorgverzekeraars (Association
of Dutch Health Insurers), the national organisation of the Dutch
social health funds. Since 1995 she has been policy advisor for International
Affairs of 'Zorgverzekeraars Nederland' , the organisation which
associates all social health funds and private health insurance companies
in the Netherlands. The member-companies of 'Zorgverzekeraars Nederland'
serve the interests of nearly 15 million insured people.
She has a seat in
the General Assembly of the Association Internationale de la Mutualité
(AIM) and she participates in the Health Insurance Committee of the Comité
Européen des Assurances (CEA). She co-edited the AIM report 'Health
protection systems today' structures and trends in 15 countries, October
1999'.
Werner B.F. Brouwer
Werner Brouwer is a health
economist, who works at the Department of Health Policy and Management
and the institute for Medical Technology Assessment of the Erasmus University
Rotterdam since 1996. He has been involved in several research projects.
Although his main field of expertise is methodological issues in cost-effectiveness
analysis of health care programmes he has also been involved in research
projects concerning cross-border provision of health care. Werner Brouwer
has published in several national and international scientific journals.
He is also editor-in-chief of the VGE-Infobulletin, the quarterly journal
of the Dutch/Flemish Health Economics Association.
Martin AJM Buijsen
Lecturer in health law
at the Erasmus University in the Netherlands. Martin Buijsen is a legal
scholar as well as a philosopher. His Ph D thesis was the precise nature
of the relationship between ethics and jurisprudence. He has written numerous
books and articles on a wide range of subjects. His publications include
articles on medical experiments involving human beings, the legal and ethical
aspects of clinical guidelines and the monitoring of illegal drug markets.
Sarah Elliston
Assistant Director of the
Institute of Law and Ethics in Medicine and Lecturer in Medical Law, University
of Glasgow. Lecturer/tutor for three Honours courses: Human Reproduction
and the Law, Law and Ethics, Genetics and the Law; Lecturer/Tutor and Supervisor
for the M. Phil. in Law and Ethics in Medicine; Tutor for First Year Legal
Systems. Tutor for LL.M. Medical Law in courses Human Reproduction and
the Law and for Law and Ethics and supervisor for this programme.
André P. den Exter
Is a research fellow at
the Department at Health Policy and Management, Erasmus University Rotterdam,
the Netherlands. He is writing a Ph D thesis on health care legislative
reforms in several Central and Eastern European countries. At the same
time he is a founding member and associate director of the European Centre
for Advanced Legal Studies in Health Care, Rotterdam, the Netherlands.
Lars Fallberg
Lars H Fallberg is a lawyer
and senior researcher and lecturer in Health Law at the Nordic School of
Public Health in Gothenburg, Sweden. He is also an advisor to the World
Health Organization in questions related to Patients' Rights in Europe.
Henk ten Have
Henk ten Have, MD, PhD
is physician and philosopher. He is working as professor of medical ethics,
and head of the department of Ethics, Philosophy and History of Medicine,
Faculty of Medical Sciences, Catholic University of Nijmegen, the Netherlands.
He is secretary of the European Society for Philosophy of Medicine and
Health Care, and Editor of 'Medicine, Health Care and Philosophy'.
Ernst H. Hulst
works as a lecturer at
the Department of Health Policy and Management, Erasmus University Rotterdam.
He has specialised himself on liability law, environmental law, patients'
rights and health insurance. He has published on these subjects frequently.
Furthermore, he is a member of the committee for education of medical-ethical
committees.
Course objectives
In general, the course
'Health Care Law from a Comparative and European perspective' aims to increase
the knowledge, understanding and experience of students in health care
law (including medical ethics). The module attempts to make students (law
students, health policy makers and other interested persons) acquainted
with both national and international dimensions of health care law. Its
relevance to Central and Eastern European students concern the effects
of international (e.g., European Union) regulation on national legal decision-making.
As such, the course attempts to contribute to the further development of
legal education in Central and Eastern Europe.
Simultaneously, the course
aims at exchanging knowledge and experiences between both scholars and
students all over Europe. Such an exchange from other countries can enhance
understanding of the meaning behind health care legal and ethical principles
and provides an avenue for shared advice among those countries with commonalities
in their systems.
Description of
the course content
The programme is the result
of the cooperation between European scientists from Budapest, Glasgow,
Gothenburg, Nijmegen, and Rotterdam.
The Intensive programme
on Health Care Law from a Comparative and European Perspective aims at
bringing together (grauduated) law students, health policy makers and teachers
from different European countries and to enhance cooperation and the exchange
of ideas. Participants are offered the opportunity to obtain knowledge
of selected topics of health care law (including ethics) from a comparative
perspective. Also they will acquire knowledge of solutions found in different
European countries for common problems.
The academic study of health
care law can be defined as 'law concerning health care'. It is characterised
as a functional discipline, i.e. defined by the various manifested
legal aspects. As such, health care law can be considered as a legal specialism
including a cross section of specific legislation, civil, administrative
and penal law. It embraces not only the practice of medicine (medical law),
but also that of non-medical health care professions, the administration
of health services and the law's role in maintaining public health. It
also means that the concept of 'law' in this context must be examined carefully.
Legal rules in strict sense, as developed by Parliament and the courts,
are not the only type of binding norms that is relevant to health care
law. In this respect international agreements on human rights should also
be mentioned.
In such a broad legal framework
in which health care law operates, the significance of human rights law
and European law is growing. Since the late 1980s, more and more European
countries have committed themselves to adopt new legislation promoting
and ensuring the rights of patients. Particularly in Central and Eastern
Europe, drastic health care system reforms have revealed the need for ensuring
patients' rights. Knowledge and understanding of these norms is therefore
essential before transforming in a national setting. Hence, the course
attempts to make students acquainted with both the national and international
influence on health care at different levels. For the position of patients
and insurees it is relevant to know the reason for this intervention, what
tensions it may give rise to and what are the possible solutions. Particularly
the influence of the European Union on health care is becoming more prominent
in (future) member states. Leading cases for the European Union Court of
Justice have increased the European dimension of health care, in particular
as concern cross border care (Decker and Kohll). It is expected that in
the near future, new rulings will increase the possibilities of cross border
care, and therefore, increase the international dimension of health care.
Legal aspects of cross border care concern the nature, scope, quality,
location, organisation and financing of provided care. Knowledge of the
specific regulations (i.e. co-ordination directives on social security)
and relevant case law is necessary to clarify the legal position of the
insured and patients in practice. The legal aspects of cross border care
are closely related to the economical perspective. To understand the concept
of cross border care in extenso, an economic introduction to cross border
care is included.
The chosen topics of the
course 'Health Care Law from a Comparative and European Perspective' have
been inspired by the close relation which exist or ought to exist between
education and practice of health care as well as between education and
research. Almost in every function in health care, one will be confronted
with health care law (patients' rights, regulation concerning the organisation
and financing, quality regulation and international treaties and documents).
Knowledge and understanding of these issues is therefore a necessity. Particularly,
the international dimension of regulating health care, its motives, content
and effects, cause key problems that national governments and health insurers
are facing for many years.
Course level, target
audience
The course is intended
for participants with some basic knowledge of health care law (legal students,
lawyers, health policy makers and other interested persons). During the
workshop sessions, the discussions require an intensive preparation of
the prescribed literature and an active role of all participants.
Syllabus
The programme is
divided in seven sections:
In section 1, general health
care legal concepts will be discussed, with special attention to the international
doctrine.
Section 2, concerns a more
specific discussion about one of the legal cornerstones of health care
rights, the right to access to health care in a national and international
perspective.
In section 3, common problems
in organising and financing health care systems will be discussed, with
special attention to market competition reforms in various countries.
In section 4, recent developments
in European health care systems will be discussed, with special attention
to cross border care and health insurance dilemmas.
In section 5, the nature
and scope of patients' rights will be discussed, with special attention
to issues such as informed consent, medical confidentiality and medical
research.
In section 6, the ethical
dimension of patients' rights will be discussed, with special attention
to issues such as ethical values at the beginning and end of life (e.g.
autonomy).
In section 7, questions
of medical malpractice and (civil) liability will be examined. Apart from
the role of medical disciplinary law and procedures for handling complaints.
If possible, the
programme will include a visit to the University Hospital, Budapest.
Theme I
An Introduction to Health Care Law (July 10, André den Exter, lectures)
- Principles of health
care law: patient's autonomy and access to health care
- Scope of health care
law
- Individual versus social
rights
- Functions of health care
law
- Types of health care
'law'; general law; professional rules; European law; human rights law
Theme II
The Right to Health Care (July 11, André den Exter, Martin Buijsen,
lectures and
discussion)
- the concept of a health
care right; scope and core content; historical evolution
- international and national
dimension of a health care right
- the right to health care
as a human right
- the right to health care
in international treaties and declarations
- realisation of the right
to health care: international and national case law
- obligations resulting
from the right to health care
- international organisations
Theme III
Regulating the Financing and Organisation of Health Care Systems: (July
12, Monica Bos,
lectures and discussion)
- Social Insurance systems
- National Health Service (NHS)
- Tendencies in health
care funding: purchaser-provider split and contracting
- Managed competition in
various health care systems
- Case studies compulsory
health insurance system reforms
- Cost containment in health
care
- Priority setting in health
care
Theme IV
Recent developments in European Health Care Systems (July 13 - 14, André
den Exter,
Werner Brouwer, lectures and discussion)
- Cross-border care between
(future) European Members States: Legal and Economic consequences to access
to health care
- Evaluation of the Effects
of Market Forces in the European Union
- Health Insurance Reforms
in the Netherlands, Germany, Hungary, and Czech Republic
- Choices in Health Care
in Italy and the Netherlands: Legal and Economic dimensions
Theme V
Patients' Rights (July 17 - 19, lectures and workshop, discussion and/or
participant
presentation)
- Legislation or Code:
'hard Vs soft' rules
- Basic Patients' Rights:
information; consent; privacy; confidentiality, competence, and medical
research
- Trends in Europe: Common
Law countries; Nordic Countries, (Central) Western Europe
Theme VI
Health Care Ethics (July 20, Henk ten Have, Martin Buijsen, lecture and
workshop,
discussion and/or participant presentation)
Theme VII
Complaints and Malpractice litigation systems (July 21, lecture and
workshop,
discussion and/or participant presentation)
- Legal systems in several
European countries
- Implementation and enforcing
mechanisms
- Complaints and malpractice
litigation in practice
Application requirements
Some basic knowledge of
health care law is recommended (legal students, lawyers, health policy
makers and other interested persons).
Non-discrimination policy
statement
Central
European University does not discriminate on the basis of--including, but
not limited to--race, color, national and ethnic origin, religion, gender
or sexual orientation in administering its educational policies, admissions
policies, scholarship and loan programs, and athletic and other school-administered
programs.
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