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Dear Sisters and Brothers: Please find attached a Special Double Issue of the latest ILC International Newsletter, with its full report on a Conference organized in Brussels by the ILC on the theme: "We must immediately stop the accelerated destruction of all systems of public healthcare throughout Europe!" Unionists and healthcare activists in the United States have long held up the European single-payer (France) or socialized healthcare (Britain) models as examples to be followed in the United States, where our system, based on profit-greedy healthcare insurance companies (they're in business to avoid the sick and insure the healthy) has resulted in 47 million people uninsured, 18,000 people a year who die for lack of proper healthcare, and 3 million people who go bankrupt because of medical bills -- and this in a country that spends twice as much money as any other nation on earth for health care! It is important, therefore, to understand that the European Union -- acting at the behest of U.S. corporate interests -- is moving fast to dismantle the tremendous healthcare gains made through bitter struggles by European workers. The European employers and governments -- all of which are implementing the European Union's directives, no matter their political hue -- are introducing into Europe our disastrous U.S. healthcare system, with its private pension funds and private insurance companies. We in the United States need to warn our European sisters and brothers about the disastrous state of our health care in the United States -- as they are being sold a false bill of goods by the privatizers and globalizers of all stripes. But we also need to know what is going on in Europe, as we have a stake to help the European workers and people defend their healthcare systems -- which are the standard-bearers for all of us. The destruction of the most advanced healthcare systems in the world would represent a terrible blow to all who fight for true universal healthcare in the United States. An Injury to One, Is An Injury to All! In solidarity, Alan Benjamin, PS We will be formating this Special Issue in the form of a brochure, in PDF format. We can send it to you upon request. PPS. Translating these brochures into English, Spanish, and other languages is costly. Much of the work is done by volunteers, but we have a paid staff to ensure the regular publication of the newsletter. As always, we need your support for our US$5,000 yearly ILC Translation Fund. Please send a check to support our translation fund to OWC, c/o San Francisco Labor Council, 1188 Franklin St. #203, San Francisco, CA 94109. Please make check payable to "ILC." --------------------
Special IssueBulletin n° 8European Workers Liaison CommitteeWe are raising a cry of alarm: "We must immediately stop the accelerated destruction of all systems of public healthcare throughout Europe."
April 2nd, 2007 : delegation to the European Commission International Newsletter International Liaison Committee of Workers and Peoples, April 17 & 24, 2007 N° 231 - 232 Price 2 euros, £1.50 87, rue du Faubourg-Saint-Denis -75010 Paris - France European Workers Liaison Committee
Is it exaggerated to speak of the need to immediately end "the accelerated destruction of all public healthcare systems in Europe?" The 15 doctors, unionized hospital workers and activists who participated in the discussion at the conference for the defense of public healthcare systems in Europe replied to this question by addressing the state of affairs in their countries. Excerpts from the testimonies, which you will find on these pages, will make you gasp, because we know that the undermining of healthcare systems and social security pose a question of life or death to all. In Germany, Klaus Schuller, leader of the DGB trade union in the Land of Thuringen and vice president of the labor commission of the SPD in Thuringen, explained that from now on a premium of 600 euros will be charged to those who for one year have not seen a doctor or had any medical intervention. In Belgium, Rudy Janssens, federal secretary of the Brussels region of the CGSP, explained that in 1971 there were 50% public hospitals and 50% private hospitals. Today there are only 25% public hospitals. The difference in each region is flagrant: in Flanders there are simply no public hospitals. In Romania, Violeta Tudor, SANITAS unionist, said it is not unusual for patients to be sent home before they are cured, because of the awful conditions in hospitals. In Turkey, Fatih Artvinli, leader of the trade union for healthcare and public services, explained: As in other European countries, public hospitals have been transformed into autonomous establishments before they are completely privatized. Certain public hospitals are simply closed. The children's hospital in Istanbul that cared for around 40,000 children a year was closed because the number of patients was considered insufficient. In Switzerland, Antonio Herranz, trade unionist, noted that the press announced there were 120,000 citizens (out a total of 7.5 million) who have no social protection. Gerard Schivardi's dramatic report states: "We, the mayors of the small communes have received the mandate of the people who elected us to represent and defend their living conditions, and improving them where possible. We have a serious problem with the closure of maternity wards. One of my colleagues, the mayor of Sarthe, told me about the difficult birth experienced by a young mother in a parking lot because the maternity ward in Amboise had been closed and she had to travel 80 kms to give birth." In Great Britain, Tony Richardson, leader of the bakers' trade union, recalls: "When I was the municipal councilor for the Labor Party in Wakefield from 1998 to 2004, I was responsible for healthcare and social assistance. During that time I was particularly aware of the state of healthcare services, and I saw how healthcare services had been reduced. Under the leadership of government representatives in the commissions, I saw the number of beds cut by 20%. In Wakefield, 80% of retirement homes and healthcare centers were privatized." In Spain, Dr. Joaquin Insausti, member of the Association for the defense of Devero Ochoa hospital, said: An infamous campaign has developed to accuse the doctors for the death of patients, whereas these deaths are the tragic consequence of the policy of privatization of healthcare imposed by Brussels. In France, the delegates were overwhelmed when they heard the testimony of Professor Guerin, president of the Association in defense of the code of ethics and the rights of patients (AMDDDM, France) and who read a letter from by Dr. Lemonnier reporting on the scandalous conditions in which aged patients, for lack of space, are virtually crammed into waiting rooms, while the doctors and nurses search with anguish for beds to accommodate them. In France we have experienced an unprecedented attack against our retirement system (reduced to 37.5 years of payment) by the Fillon Law of 2003, following the Balladur measures of 1993. In Germany the age of retirement has been increased to 67 years, in Hungary to 65 years. Is this a simple coincidence asks Nicole Bernard, a social security unionist? "Isn't it the dictate of the European Union's recommendations, and in particular the Barcelona summit of March 2002, which recommends in Point 32 of its list of conclusions to progressively increase by five years the effective age in which professional activity ends in the European Union? Isn't the closure of millions of beds, complete hospitals, the consequence of the policy of the European Union as advocated at the Summit in Thessalonica in June 2003, ordering surveillance of the efficiency of measures taken to unravel the spiral of expenses in the healthcare sector and take their evolution to a more supportable level?" This also applies to countries that are not yet members of the European Union In Turkey, Fatih Artvinli indicated that the implementation of the plan proposed by the International Monetary Fund that increases the cost of medication by 60% is one of the conditions demanded by the European Union for Turkey to be able to join. So, what can we do for the defense of our healthcare systems in Europe, asks Fulvio Aurora, member of Democratic Medicine and leader of the healthcare commission of the Party of Communist Refoundation in Italy? The discussion brought up answers. "We are here, doctors, hospital workers, leaders and trade union activists, and it is natural that we fight within our organizations to defend our hospitals, the status of personnel and through them, that of the patients," said Luc Delrue, hospital unionist (France). In Great Britain, numerous initiatives have been taken by trade union organizations over the past years, to defend a hospital, and the NHS in general, said Tony Richardson. Philippe Larsimont of Belgium, who presided the conference, read a message from doctors, trade unionists and Portuguese socialist activists that recalled the large demonstration these last few weeks of the people, their elected representatives, and the trade unions for the defense of healthcare emergency services. In Germany the massive rejection of the "healthcare reform" by 80% of the population led several deputies of the SPD in the Bundenstag to vote against this counter-reform proposed by the government of the "grand coalition". It is not only about the defense of what is left, but also recovering what has been taken away, because what is at stake is civilization! This struggle is linked to the fight on a European scale to have the European Commission face its responsibilities in addressing the dramatic state of affairs of public healthcare systems. Some delegates explained that they reached the conclusion of the need to break with the European Union. Others did not share this point of view, but all participants recognized the crushing responsibility of the European Union in this situation.
The 72 participants at the meeting on March 31, 2007 mandated a delegation made up of Fatih Artvinli (leader of the healthcare and public services employees' trade union, Istanbul, Turkey); Hans Mees (leader of the Ver.di trade union of the hospital group VKKD in Dusseldorf and member of the leadership of Ver.di-healthcare in Rehnanie); Henning Frey (member of the SPD, Cologne); Rudy Janssens (federal secretary for the Brussels region CGSP ACOD ALR LRB, Belgium); Philippe Larsimont (coordinator of the Workers' Defense Movement, Belgium); Nicole Bernard (social security unionist, France); Philippe Navarro (hospital unionist, France): Christel Keiser (European Workers Liaison Committee). The delegation was received by Philippe Brunet, director of the European
Commissioner's office for healthcare and the protection of consumers,
and Markos Kyprianou. Brunet explained to the delegation that "the
European Commission has neither competence nor responsibility in the
organization or furnishing of healthcare. No one in Brussels says one
must reduce healthcare expenses. The only thing imposed by the European
directives is the fight against public deficits." This is the mandate given to the delegation endorsed by the 72 participants: We, the undersigned doctors, hospital workers, social security personnel, unionists, worker activists, gathered on March 31, 2007 in Brussels in the framework of the appeal launched by the European Workers Liaison Committee. We have established the following: In all European countries in reference
to the European directives, our public healthcare systems and those
of social security have been dismantled, thereby upsetting the equality
of access to healthcare. We consider that memorandums that we have established in each country allow us to make the following accusation: This policy of destruction is without any doubt coordinated by the institutions of the European Union. Is it not the European Union that requires each member state as well as each region, to strictly respect the rules of the Stability Pact and reduce the public deficit to less than 3%, as fixed by the Maastricht Treaty? Is it not the establishment of Article 104 of the Maastricht Treaty that stipulates: (1)The member states must avoid excessive public deficits; (2) The Commission supervises the evolution of the budgetary situation and the amount of public debt in the member states to detect manifest errors?" Article 104 specifies what is to be understood by public: "What is relative to general government, that is to say central administrations, regional or local authorities and social security funds." Didn't the Italian government implement this article when the finance law for 2007 foresaw the suppression of 3 million euros to the healthcare budget in order to reduce the public deficit to 2.8%? Was it not the European Union that decided to increase the retirement age when it indicated in its conclusions at the Barcelona Summit in 2002 that: "Beginning here and through to 2010 we must progressively increase by five years, the average age in which professional activity ends in the European Union?" This obligation is confirmed in the integrated directive line No. 2 of July 12, 2005, which stipulates: "The member states must take into account the costs of an aging population, 1) Reducing their debt at a sufficient rhythm; 2) reform their retirement system, their social security and healthcare in order to render them financially viable?" Also through the document of the European Commission of January 25, 2006 titled, "Let us rapidly pass on to: the new partnership for growth and employment" that requires: "In the framework of their reforms of public retirement systems, member states must reinforce the financial incentives for workers who continue to work, for example by adapting the legal age of departure to that of retirement?" Is it not the integrated directive No. 15 of the European Union which stipulates: "The member states must strengthen the economic incentive measure including a simplification of fiscal systems and a reduction in the non-wage cost of labor" which imposes the exemptions from employer contributions and organizes the plunder of social security and retirement funds? Doesn't the report of the European Commission on Social Protection and Social Inclusion, published on February 19, 2007 imposing "fixing ceilings for expenses, the participation of patients in the costs of benefits" which leads to an increase in the costs borne by the insured? On September 26, 2006, the European Commission published a communication on healthcare services launching a "public consultation." It asks for "the respect and responsibility of the member states in the matter of healthcare services and medical care," and further, "The Justice Court declared that this disposition does not exclude the possibility of imposing on member states adaptations to their national a system of social security, as in other dispositions of the Treaty as in article 49 CE that stipulates: The restrictions on the offering free services within the communities is forbidden." Is the objective of this future directive not to get rid of the national systems of social security? These facts raise one question: Is the defense and reconquest of our public healthcare systems compatible with the European Union and its directives? There may be many answers, but this question must be debated by all those who are attached to the defense of public healthcare systems and social security. We, the undersigned, have decided that the mandate of the delegation to be received on April 2, 2007 by the institutions of the European Union is to obtain answers to these questions, on the basis of the facts we have explained and the memorandum we have constituted. We have decided to deploy all our forces to defend and reconquer our public healthcare systems and our social security systems. We have participated in numerous demonstrations against the closure and/or the privatization of our hospitals, against the undermining of our retirement systems, against the decrease in budgets allotted to healthcare, etc.
I publicly support this mandate Name : .............................................................................................................................. I -Hospitals closed since the Maastricht Treaty was ratified
Article 104 of the Maastricht-Amsterdam treaty stipulates: "1. Member States shall avoid excessive governmental deficits.2. The Commission shall monitor the development of the budgetary situation and of the stock of government debt in the Member States with a view to identifying gross errors(.) it especially examines compliance with monetary discipline according to the two following criteria" On June 17th 1997, the Amsterdam European Summit adopted a resolution relevant to the "Stability and Growth pact". This resolution, part of the constitution of the Stability pact, stipulates: "Member States pledge to respect the middle term objective of a balanced or positive budget, in conformity with their stability or convergence programmes and to take corrective budget measures to reach the objectives announced in the stability or convergence programmes" The protocol on the procedure concerning excessive deficits attached to the treaty adds: "In Article 104 of the present treaty and in the present protocol what should be understood as public includes what relates to general government, meaning central administrative bodies, regional or local authorities and social security funds". This means that healthcare expenses are comprised in the criteria of budget limitation in the name of excessive deficits. What are the consequences for patients and staff? France 180,000 hospital beds have been closed down, among which 83,000 between
1992 and 2003; One case among others, the closure of surgery wards:
Last March 20th a school headmaster wrote to the mayor of his village:
Germany
A May 2005 paper on healthcare in Belgium enabled the OECD to sate
that: "The government can encourage hospitals to cut the number
of beds in excess(.) Authorities intend to reinforce specialisation
and co operation between hospitals by planning the offer of hospital
service according to 'healthcare market areas'. Britain Between February and November 2006, 21,000 jobs were made redundant and the government plans thousands of others! Job cuts in the NHS: Nationally: On the regional and local levels: Denmark The European Union requires competition: public hospitals and private
ones must be on an equal footing. It is a direct attack against public
services and against the system founded on solidarity. Italy What about the countries that recently joined the European Union? Hungary In Hungary, the year 2006 has not been a landmark of success for public healthcare. It will rather be recorded as the year that clearly shows that those who claimed they were the spokespersons of the interests of the sick, were certainly not entitled to do so (.)The government submitted its convergence programme to Brussels at the European Commission, against the general opinion of all the workers. The draft, dubbed "reforms for convergence" for 2007 and the public healthcare budget are the exact opposite of constituents' wishes. Currently, there are about 80,000 hospital beds. This year, the number
is slated to drop to 71,000. "Last Thursday, the government ended free healthcare. From now
on, patients will have to pay a 300 forints (1.2 ) set charge for
calling on a doctor and for each day in hospital. Romania We used to consider healthcare as a matter of public interest. The health of a nation depends on the health of its members. In this sense, free and unrestricted access to medical services was to be given priority. It was a norm we had enjoyed for years; one of the great conquests gained after the Second World War. Free healthcare survived till January 1st 1999. Before 1999, healthcare was free of charge. As private healthcare insurance got a foothold, this led to a scarcity of drugs and sanitary equipment, the closure of hospital units, the reduction of the number of beds and it brought investment to a halt. The result of this is that some patients die in hospitals or right on the hospital door-step because some are "outside the healthcare insurance system" and cannot use those services. There are cases where people are known to have been taken to hospital in ambulances and "dropped" on the pavement and left there to die. That is not the end of it and the destructive process continues; with the excuse that we have too many hospital beds (whereas two patients often have to share one hospital bed), they have been closed down; even entire hospitals or entire wards have gone. The "argument" is that, in the E.U. the average number of beds is 4.2 for 100 inhabitants whereas, in our country, the average is 7.2. Is it true that there are too many hospital beds? Not really; in fact, it is another ploy to cut the funds for hospitals. Here is what some of the Dolj department trade union leaders declared
when the problem of closing down the Poiana Mare Hospital was raised:
"People are terrified. We received a letter encouraging us from
all the SANITAS section of the Oltenia region. I can say that during
the night, we received threatening messages on our mobile phones, telling
us that if we did not give up, we would be shot at with rubber bullets.
The messages were interrupted when we called on the local police."
declared Ileana Ionescu, who chairs the Dolj department branch of the
SANITAS trade union. Marcel Ticu, shop steward of the Poiana Mare neuropsychiatry
hospital workers declares that the 300 hospital workers have announced
their decision to resign if the decision to close down the hospital
was not cancelled. Switzerland is not a E.U Member State but it suffers all the consequences
of the Stability Pact. Currently, it is the hospital staff statuses, collective agreements and other such guarantees that are under fire; this goes along with wage cuts that can amount to as much as 1,000 Swiss Francs (about 650 ) a month!!! EU policy is manifest in the setting up of hospitals serving several
cantons; these are structures that have no legal nor administrative
basis, which leave space only for private hospitals where hospital staff
have no status. In those sectors, working conditions are reminiscent
of the 19th century; people work on call, they can work as long as 70
hours on end in operating theatres and emergency wards. This in total
disregard of the law as well as safety rules. Hospital bed closure in the Vaud canton II. The European Union policy is destroying healthcare and social protection system across Europe. This fact can be seen everywhere: all the social security paying offices
are allegedly in deficit. First, it is necessary to put things into their true light: Social Security coffers have been emptied on the one hand by exemption from payroll contributions offered to employers and on the other hand, by measures shifting social security on to general taxation. In France, employers have been offered as much as 175 billion exemptions from their social contributions during the period from 1991 to 2005 . The draft budget for Social Security funding in 2007, provides that, in firms employing fewer than 20 workers, employers will be exempted from paying their 2.1% contributions on minimum wages. For the sole 2005 year, employers pocketed 23.6 billion exemption from contribution. In Germany, the healthcare "reform" voted in Bundestag last February provides for further exemptions for employers. In Italy, till 1996, healthcare expenses used to be funded through "national compulsory healthcare contribution" paid by wage earners, on the one hand, and employers on the other. In 1996, the first Prodi government scrapped this contribution and replaced it by a tax calculated on a regional basis; the goal was to bring down employers' contributions. To this must be added the fact that exemptions for employers amount to a yearly 9 billion . In Belgium, employer contribution exemptions take a yearly 6 billion bite. In Hungary, the government has reduced its payments into the healthcare paying office (which is state funded in Hungary) by several billion forints. In Romania, the attack has also come under the form of shifting healthcare funding to general taxation. Thus, till 1999, healthcare used to be free of charge. Since then, the government has introduced social insurance and, in 2002, the CNAS (National Healthcare Insurance Office) came under the control of the healthcare Ministry, which enabled the government to funnel the money normally affected to healthcare to other sectors. Thus the funds made available to healthcare insurance offices for drugs currently runs dry on the first day of each month. People therefore have to pay. That is also what happens in Turkey. The SSK (Social Insurance Institution) that gave free healthcare to the people has been transferred to the Ministry of Health, which has paved the way for the privatisation of a number of services. It is the European Central Bank that gives the pitch and summarises the European Union's goal in its April 2003 monthly letter: "The ageing of populations will have a considerable impact on euro zone economies (.) Public expenses in healthcare and long-term treatments will increase in relation to continued medical technique advances while in these services, demand will increase with the increase of an ageing population. Moreover, the slowing down of economic activity and therefore the tendency to change employment of ageing workers exerts pressures pulling economic growth downwards(.) It is necessary to harbour no delay in the implementation of these reforms in order to be able to deal with an increasingly ageing population (.) These reforms should make public retirement systems financially sustainable as well as provisions for healthcare and long-term treatments by restricting the intervention of the public sector and facilitating private financing."
What has caused this looting that plunders social security funds at the expense of the right to treatment? The European Union and its integrated guidelines. EU integrated guideline N° 15 that stipulates: "Member States should reinforce measures of economic incentives, including simplifying tax systems and reducing non-wage costs of labour" What the EU coins "non-wage costs of labour" is postponed
wages [the part of wages that employers have to pay into social security
offices towards public healthcare insurance and retirement pension -
TN]. Here is how the French government met this order in its National
Reform Programme: "In France, we have constantly made it our policy
to alleviate the burden of payroll contributions on low wages. Indeed,
some 20 billion are currently earmarked to diminish employers'
contributions (.) These measures have been a continued effort since
1993 when they came into being." 1. All the single payer retirement systems are under threat and retirement age is increased everywhere. The March 2002 Barcelona Summit indicated in its point 32: "By
2010, median collective cessation of professional activity should be
progressively increased by about five years" How are these measures translated into the different European countries? In France, in 1993, Balladur's counter-reform was adopted just after
the Maastricht Treaty was promulgated. The latter imposed the well-known
convergence criteria (especially making it an obligation not to exceed
a 3% GDP deficit) and integrated Social Security expenses into this
stranglehold. Then, in 2003, Fillon's counter reform increased retirement
age (from 37.5 years to 40 for public sector workers, 41, then 42 for
private sector workers) 2) Developing self-medication. In France, a report compiled at the behest of the government encourages
"users to purchase drugs from chemists directly without first calling
on their GPs., which means they are not reimbursed." "It would
need just 5% of prescription drugs to be used as self-medication to
economise 2.5 billions" 3. Developing the generic drug market In France, law N° 2006-1640 voted on December 21st 2006 on Social
Security 2007 budget and published on December 22nd in the official
Gazette aims to bring the Social Security "deficit" from 10
billion in 2006 down to 8 billions in 2007, compared with a total
295.5 billion expenses -exceeding the state budget - 267 billions -
to implement article 104 of the Maastricht Treaty. 4 - Other measures levelled at social security members ? In France: patients who do not abide by the standard prescribed process
are penalised (1 per visit or medical act) and who do not first
visit the family/referent GP (the patient must pay an excess 10% in
case he/she directly goes to a specialist doctor's), the set price that
patients must pay for in hospitals has increased by 14.3% in two years
in France) some set prices have to be paid for by the patients (18
for medical acts above 91 ), threats over the 100% reimbursements
for patients undergoing long treatment due to their specific disease; 5) Ending the monopoly of social protection systems. In France, patients are encouraged to pay ever mounting prices for
added insurance coverage. Meanwhile some acts that, up till now , were
paid for by Social Security offices have been outsourced: for instance,
cleaning, printing, training; Social Security forms are taken care of
by private firms; paying offices close down one after the other and
paying call centres are set up where they cannot look into social security
member's files. The European Parliament resolution 2000/2009 "considers that supplementary
health insurance in the internal European market will play an increasingly
important role in covering various health risks". Accordingly the
European Commission considers that the Belgian law on private sickness
funds of 6/08/1990 "has not correctly and completely implemented
the provisions" of two directives (73/239/CEE and 88/357/CEE on
insurance companies' freedom to provide services). The Belgian government
is accused of favouring mutual fund societies which compete with private
funds in the market for cover complementing the statutory healthcare
system (hospitalisation cover, home care, etc).
III - Public-Private Partnerships (PPP) The Public-Private Partnership (PPP) is at the heart of the European Union's regulatory approach which in a Green Paper the EU terms a 'general interest service' associating public services and private companies. In its monthly letter of April 2003 entitled "The need for comprehensive reforms to cope with population ageing" the European Central Bank made clear that "comprehensive reforms need to be implemented swiftly to cope with the effects of ageing (…) Reforms should place both public pension systems and health and long-term care arrangements on a sustainable financial footing by limiting the public sector's exposure, enhancing private funding and setting incentives for efficient service provision." Albeit in sometimes differing forms in different countries, public private partnerships are therefore in store for all European Union countries. Great Britain The financial instrument of public private partnerships is the PFI (Private Finance Initiative). It was developed by the Thatcher government which used it for the privatisation of the railways, and has since been used by the Blair government. Between 1998 and 2005, the European Investment Bank has lent in excess of one billion pounds sterling to set up PFIs. A PFI functions as follows: the state gives over to a private investor the cost of building, developing and maintaining a hospital. There is obviously a reward. Private companies and their boards which demand investment returns over 10% a year are not philanthropists. The state thus commits itself to paying an annual rent for 30 years. According to the British Health Ministry itself, the building of a private hospital costing the public service's private "partner" 8 billion pounds will end up costing the NHS 53 billion in rent over 30 years. In reply to a Conservative MP's oral question at the House of Commons, the government disclosed that the total current cost of PFI in the NHS is 45 billion pounds for 2006 alone. An amount paid by the taxpayer which largely exceeds the so-called NHS deficit and which, were it invested in the public service following a re nationalisation law, would be enough to restore definitively a free and universal health service. There is no NHS deficit in Great Britain. Let us turn to what these 30-year contracts stipulate. The contract signed by the Worcestershire Royal Hospital is a case in point. In 2003, according to official figures, this hospital posted a "deficit" of 22 million euro. Management then decided that the hospital would have to work at 98% capacity, by imposing drastic measures on staff, in order to "recoup" this "deficit". However, one of the clauses of the contract signed 7 years earlier
with the company Catalyst foresaw that the hospital could under no circumstances
run at over 90% of its capacity! The Worcestershire Royal Hospital was
accordingly condemned to pay a 292,000 fine to its partner, Catalyst! Let us now turn to the town of Lymington, where there is currently a PFI project for the construction of a new private hospital which will compete with the existing hospital. According to the local trade-union organiser, there will no longer be a maternity service, and neither will there be a service dedicated to the disabled. There are thousand of examples like these. On the pretext of reducing a non existent deficit, with the NHS now converted into a lessee under Brussels' and the governments' orders, thousands of beds, services and jobs are suppressed (see part I) .in order to be able to pay an annual rent to private companies. Italy In Italy the process of privatisation of health takes the form of conventions signed by the public health system - regionalised as a first step - and the private sector. First USLs (Local Health Units) were transformed into companies. Then
at a second stage regionalisation came along. USL directors found themselves
more directly dependent upon the Regions - a level of power which exerts
direct and closer control. Any budget overstep is drastically punished
and the director risks losing his job. Budgets of hospitals, services,
etc are based on the need to control costs rather than on medical requirements
as before. Directors who manage within their budgets and cut back on
funds get bonuses. Regions are subsidising more and more private hospitals through the 'convention' process. France Public hospitals are bound to indebt themselves either directly or through public-private partnerships (PPP). In order to acquire grants, health establishments had to accept making special efforts, either drawing on their own funds or resorting to credit. This was not without consequences, as a study by the research and rating agency Fitch Ratings shows. This study, made public in January 2006, shows that hospitals' debt could double over the next five years. The agency states that "in order to modernise their buildings and equipment, public hospitals are called upon to indebt themselves either directly or through public-private partnerships (PPP) ". According to Nicolas Painvin, the analyst who authored the study, "in view of the 'Hôpital 2007' plan and of the recently announced 'Hôpital 2012' plan, hospitals' debt is bound to increase". As he explains, "the rationale of the Hôpital 2007 plan comes down to this: 'you need to invest and we will help you to indebt yourselves'"; further "Hospitals have significant investment needs. Lenders wonder about hospitals' long term solvency. True, in the short and medium term the question does not really arise. On the other hand, in the long run, it is a real question". In addition, the budgetary situation of health care establishments
is, at the very least, strained. According to 2006 figures communicated
by DHOS, 34% of such establishments' projected profit and loss accounts
showed losses, while 43% had to draw on their working capital. Inevitably,
this will have an impact on investment and will lead to the investment
capacity of certain establishments drying up. It is even worse as far as the disabled are concerned, with the Montchamp law; the management of the MDPH (departmental office for disabled persons) and of the new departmental disability compensation fund is entrusted to a GIP (Public Interest Grouping) which brings in private interests: associations, health care management bodies, "services intended for disabled persons [or] ensuring a coordination mission". The new law thus generalises the state's disengagement and the privatisation of disability guidance and assistance. Spain The Aznar government devolved health care to the so-called 'autonomies'. The Zapatero government gave up on increasing public expenditure on health care. The upshot is e.g. that the Valencia community handed over health care for the Alcira sector to a hospital which is owned by Sanitas, an insurance company. The Madrid community launched the building of seven new hospitals following the public-private partnership (PPP) procedure. This means it delegates the control of the works to financial structures which take charge of the construction and maintenance of whole services, thus opening real estate speculators scope for expansion into the area of health care.
On pretext of unsatisfactory management of public hospitals and of the annual budget deficit of certain hospitals, the 14 regions created in the country have undertaken to transform public hospitals into mixed economy companies - i.e., are on the way to privatisation. Hungary For years discussions have been ongoing on privatisation and which form privatisation should take: partial or complete. In certain hospitals, certain activities are already entrusted to private structures - maintenance and servicing, administration and also laboratories and X-ray services. Such privatisations involve making 10% of staff redundant as well as the loss of social benefits (including job safety) for the staff not laid off.
Regionalisation is one of the instruments used by the European Union to privatise the public health system, particularly after the Maastricht Treaty entered into force in 1992. Two examples in Europe provide ample evidence: Italy and Spain. Italy
The first transformation of the system consisted in turning USLs into companies (local health care companies, ESL). That was the first step in implementing the Maastricht Treaty. The directors of these ESLs (ASLs) then brought in private management standards. The second phase was regionalisation, which took place under the 1996-2001 centre-left government, which devolved all management of national budgets to the regions. It fell to them to enforce the Stability Pact directly. The regions were obliged to choose: either cut back services directly, which led to the slashing of thousands of hospital beds, staff layoffs and hospital closures, or increase expenditure charged to patients ('health ticket') and increase regional taxes. It should be noted that the regionalisation of health care was inserted into the first (federalist) reform of the Constitution brought in by the centre-left government in October 2001. This reform introduced the principle of subsidiarity in the Constitution as well as compliance with European policy. This reform sanctions the regionalisation of health care. Consequences: certain regions, like Sicily, put hospitals on sale in
order to comply with the Stability Pact. For example, the inhabitants of Emilia Romagna who live close to Veneto prefer going to Veneto services because the latter region is richer, and therefore has better services. Yet, as prescriptions delivered by a doctor from one region are not recognised in another, treatment begun in one region must continue in that same region and medicines must be bought there. A citizen moving from one region to another will have to redo their medical consultations to get valid prescriptions. An official report indicates that a patient who chooses to pay only the fixed rate will on average have to wait 40 days for a consultation or a test. However, the waiting time for a scan in Naples is 113 days, and for a cardiac check-up in Monza 180 days. Regions have started to subsidise private hospitals or to introduce private services in public hospitals. If the same patient who was to wait 180 days for a cardiac check-up chooses the private service in the hospital, the waiting time comes down on average to… four days! But the cost of the private consultation ranges between 40 and 250… The new Prodi government is now proposing a new reform of the Constitution which would allocate to the regions full authority on health care, education and taxes. This would mean that the regions would narrowly depend on the limits dictated by Brussels. Spain It should first of all be born in mind that after Franco's death in
1975 the workers' movement and their trade unions have imposed the unification
of health care networks which before depended on the individual administrations.
While under the dictatorship health care services came under the authority
of local and regional authorities, specialised networks like hospitals
treating tuberculosis also depended upon one separate administration,
all that was then merged into one single network. This single national
level network also unified working conditions and merged the hospital
workers' separate status into the general public service status. The Ministry of Health has become an empty ministry which only controls the health care networks of the Moroccan cities under Spanish control, Ceuta and Mellila, while the 17 regions have full authority. For example, in the region of Andalucia an Andalucian health care service and public-sector health care companies were established, but these companies' staff do not enjoy the same status. They have private law contracts and 30% of their wages depend on productivity. Hospitals are thus managed e.g. by religious orders as is the case of Aljarafe hospital. But as the church is opposed to birth planning, this hospital does not provide termination of pregnancy. In the region of Valencia, the de la Rivera hospital, which is a public
hospital, is nevertheless managed by an insurance company called Sanitas.
In Madrid, there is a plan to build 10 hospitals which will be managed
by private companies. In parallel, the offensive against the doctors
of the Leganes hospital (see the Léganes Doctors Association's
appeal, page 38) simply looks to turn the public hospital into a - public/private
- Foundation. At the time this offensive failed because of workers' resistance and mobilisation across the country. Currently in each region they are trying to implement privatisation measures on the basis of an agreement on financing concluded in September 2005 under the current government. This agreement is based on strict compliance with the Maastricht criteria. This quickly led to patients getting different treatment in different regions, depending on the latter's income, for each region has authority to levy taxes, modulate patient contributions or look for other resources. There is, however, a further question: there is a radical change to doctors' and other health care staff's working conditions according to regions. For example, a long article in El País of 14 March 2007 carried the following headline: "18 territories, 18 health care curricula". The article set out wage differences in detail. These differences can reach 2000 euros between a doctor in Barcelona and a doctor in the Galicia region. V -The rights of the disabled challenged In France , the Montchamp law is claimed to be "progressive for disabledpeople" In fact this law undermines the main articles of the Orientation Law of 1975 (called the "Lenoir Law). It brings in changes in the Family and Social Action Code as well as in the Education Code which made it compulsory for the State to provide schooling for all children; either in an ordinary school, or in an establishment or specialised structure when necessary, according to the nature and the degree of handicap and /or difficulties of the child. The new Law makes it compulsory for the "public service" to provide schooling in "an ordinary environment", no longer respecting the rights of the disabledchild to have the benefit of indispensable specialised means for his or her education. This Law programs disabledchildren's transfer from specialised establishments to ordinary schools , which do not have a structure or qualified, specialised staff adapted to the nature and degree of their handicap. It is easy to perceive how this Law cuts costs. A child in a specialised establishment costs on average, 25 000 euros a year as against 7 000 euros in an ordinary school. Several disabledchildren could be put in each class, integrated on the basis of a personal project which does not have to follow the national school curriculum that the teacher is supposed to respect in his or her classroom. At the same time as the State does away with its duty to provide specialised care for these children , it disrupts classes through generalising modular teaching which replaces school curriculum. What does the Montchamp Law stem from ? Who could be against non-discrimination ? Nobody of course ! The Montchamp Law appears to be founded on this principle , in fact that is , on the European directive of the 27th November 2000 which stipulates that disabled persons be "guaranteed" accessibility to lodging, to transport and work posts …. On the condition that the necessary transformations be "reasonable ", that they respect the "principal of reality and do not entail "disproportionate expense" for employers ! The European Union Council resolution dated 5th May 2003 recalls in
point 2: "the treaty that set up the European Community gives the
Community the possibility of adopting measures aimed at fighting discrimination
based on (….) a handicap (..) while fully respecting Member State responsibility
for the content of teaching and the organisation of the education system."
No more discrimination ? They have the "right" to apprenticeship
and casual , precarious jobs. In point 7 , one can read in effect: "so
that disabled persons get better access to teaching and training with
the view to life long education." No more discrimination ? They have the "right" to have no
more specialised establishments: "The trap of high benefits"… The Communication from the Commission to the Council, to the European Parliament, to the European Economic and Social Committee and to the Committee of the Regions of 28 November 2005 uses the concepts (page 3) of "equal treatment, independent living and participation in society" - not to be mistaken for the right to live in society! "Given the current demographic situation, the economic potential of disabled people and the contribution they can make to economic and employment growth must be further activated on the basis of the Social Agenda for 2005-2010 (…) in support of the refocused Lisbon strategy, (…) calls on Member States to promote inclusion of disabled people in their forthcoming Reform Programmes for growth and jobs." In the same document, the European Union notes that the "The inactivity rate of disabled people is twice that of non-disabled people". Every worker knows that this protection of the disabled vis-a-vis work, vis-a-vis the exploitation which creates increasingly difficult conditions of life for the non-disabled is an entirely positive civilisational acquis… Well, for the European Union it is the opposite: "Benefit traps and risks of losing benefits on starting work are major disincentives." (page 5). And in case anyone hasn't quite got it yet: "disability schemes affect early retirement. This calls for disability actions to further support labour force participation and promote active ageing, notably to prevent early retirement." In plain English: dismantle disability schemes to get the lazy disabled back to work! Well before this recommendation, Tony Blair had already made great such strides in Great Britain - causing a major political crisis within government itself in the year 2000… For the European Union, the disabled represent a potential labour force reserve deliverable to capitalists' exploitation. The European Union's statistical studies indicate that 44.6 million people consider themselves to have some disability - 16% of the working-age population. "Many disabled people have the ability to work, hence the crucial importance of work situation adjustment. (…) the working-age population as a proportion of total population is falling. It is now more important than ever to make full use of the available working population, including disabled people." (Page 4) The Montchamp law precisely reforms the so-called "protected work" sector, in particular protected workshops, which become "adapted companies". Such companies can now be set up by for-profit companies, rather than just by local associations or authorities… Don't start dreaming, though, disabled workers will still not enjoy the same rights or wages as the able: for the French government, as for the European Union, "non-discrimination" is a variable geometry concept!
Christel Keiser (European Workers Liaison Committee, France) In the name of the European Workers Liaison Committee, I present the information contained in the memorandum we constituted with the information we have received. If you are in agreement, we will take this memorandum to the representatives of the European Commission who will receive us next Monday. The memorandum will include the information you have given us following this meeting. We ask for answers to our questions. It is necessary to agree on the report we have all produced: in our countries, particularly after the adoption of the Maastricht Treaty in 1992, we are confronted with the dismantling of our public healthcare systems and our social security systems. The conditions we have begun to address are evidence of one thing: this policy of dismantling was implemented by governments, regardless of their political leanings, since it is the result of the application of the European Union's directives. I refer to two questions that are essential: the restriction on healthcare
expenditures in all countries and the dismantling of the social security
systems. These are the figures: " Between 1992 and 2003, 86,000 beds were closed in Germany, 83,000
in France What are the consequences for the patients and the personnel? Here are excerpts from a French doctor, following the press conference of the Medical Association in Defense of the Medical Code of Ethics and the Rights of Patients, held last February 13: "The government asked a professor to establish a list of surgical services to be closed. Mission accomplished: a list of 113 services that should be closed was sent to the public powers. Our country only has 480 surgical services. Therefore one quarter of these services will be closed! The same argument that served as a pretext to close millions of maternity wards, with the consequent catastrophes: deaths of newborns, home births or in parking lots, deaths of pregnant women. In order to justify this decision they said these services were not often required. The bar was set at 2,000 operations a year. Why 2,000? Why not 1,000 or 3,000? On what medical studies are they based on? What is the real reason? At the Thessalonica summit on June 21, 2000, a recommendation was made
to France: "Actively supervise the efficiency of measures taken
to untangle the spiral of expenditures in the healthcare sector and
take their evolution to a more bearable level and if necessary, adopt
new measures in order to attain this objective." In Denmark unionists explained that the number of treatments in private hospitals increased, while minor public hospitals were closed. Since January 1, 2007 small hospitals and public hospitals with smaller capacity have been threatened with restrictions because of the reform of municipalities. Millions of beds were suppressed and numerous services closed, personnel was reduced, particularly that of nurses. In Italy a doctor testified: "For all workers and those who cannot afford private insurance, healthcare is a problem. Many people die from curable illnesses that have been diagnosed badly or too late. I know of a case where a person with a serious tumor who needed urgent care was given an appointment for 40 days later, here in the Piedmont!" In Hungary, the French newspaper Les Echos of February 19, 2007 indicated: "The Hungarian government ended free healthcare. Patients must pay a fixed rate of 300 florints (1.20 euro) for doctor visits and each day of hospitalization. This increased is one of the numerous measures that Budapest has decided to apply in order to fill public coffers. The government announced it would be closing seven public hospitals shortly." In Romania a healthcare unionist informed us: "Under the pretext that we have too many hospital beds (in conditions where some patients shared one bed), the reduction of these continues, as well as the liquidation of certain hospitals or part of their sections. The argument is that in the European Union there are 4.2 beds per 100 inhabitants and in Romania the average is 7.2. Are there really too many beds? There aren't, it is just a ruse to reduce the funds allotted to hospitals." In Switzerland unionists say: "In our country, that is not a member of the European Union, but suffers the consequences of the Stability Pact, the implementation of austerity policies 'a brake on indebtedness' that conforms to the criteria of the Maastricht Treaty, has resulted in massive closures of intense care beds, to the closure of local hospitals, maternity wards, emergency services, etc. Presently the statutes, collective bargaining and other guarantees for the personnel has been set back as in Neuchatel where wages were lowered up to 1,000 Swiss francs a month (650 euros). In pediatric intensive care, they have asked the families to monitor their premature babies!" After months and years strikes and demonstrations increase throughout Europe against the closure of hospitals, maternity wards and reforms to the healthcare system. In Great Britain, where millions of people have demonstrated in the villages against the closure of local hospitals. In one location, 130,000 people signed a petition against the closure of the maternity ward. In this same town, the local director of the NHS (National Health Service) resigned in order to protest against the government's plan. She explained: "Over the past five years, I have tried to weigh the policy of management. I am concerned about the use of private companies in the NHS." The secretary of the British Medical Association warned: "We have one year left before the healthcare service is wrecked." In Germany, last October, millions of workers called up by the trade union organizations, demonstrated against the healthcare reform. In Denmark, local demonstrations were held against the closure of local hospitals. There were also strikes in important hospitals. Recently, over 60,000 people demonstrated against restrictions imposed on the Funene Island hospital. In Hungary, local demonstrations that included patients, inhabitants and hospital personnel were organized to defend local hospitals. In Romania, when the problem of the closure of a local hospital arose, trade union leaders called for a strike and declared: "We have received messages of encouragement from all the affiliates of trade unions in the region. This could also apply to France, Italy, Switzerland, etc." Who imposes the closure of hospitals, beds, services, suppression of jobs and budgetary restrictions? We refer to article 104 of the Maastricht Treaty that stipulates: The protocol on procedure regarding excessive deficits, annexed to the Maastricht Treaty specifies: "In article 104 of the treaty and within the present protocol public is understood as: what is relative to general government, that is to say central administrations, regional or local authorities and social security funds," that includes all healthcare expenditures. On June 17, 1997, the European summit in Amsterdam adopted a resolution relative to the "Stability Pact and Growth." This resolution of the Stability Pact stipulated: "The member states undertake to respect the budgetary objective in the short term in a position close to the balance or surplus, in conformity with the stability or convergence programs, and to take corrective budgetary measures they judge necessary in order to attain the objectives set out in their stability or convergence programs." It is therefore in respect for article 104 of the Maastricht Treaty and the Stability Pact that three million budgetary cuts for healthcare have been inscribed in the Italian finance law voted on December 2006 in order to "reduce the public deficit to 2.8% as of 2007." This occurs in all European countries. In Hungary, Les Echos of France reported on February 19, 2007, that "the national deficit should have reached 10% last year. The finance law of 2007 foresees lowering this ratio to 6.8% of the PÏB. The 3.2% cap should be reached by 2009." A report from the European Central Bank states that in Great Britain, there is "an incompatibility between the existence of the NHS and the Stability Pact." In most countries the restrictive policy goes hand in hand with a policy of privatisation The public private partnerships (PPP) are at the center of an operation implemented by the European Union named "general interest services" in their Green Book, associating public services with private companies. How does this work in Great Britain? The state requires the private investor to assume the cost of construction, development and maintenance of a hospital. Obviously there is compensation. The private companies and their boards demand returns on their investments of at least 10% per annum. The state then undertakes to pay an annual rent for 30 years. According to the British healthcare minister, the construction of a private hospital costing eight million pounds to private industry the will end up costing 53 million pounds in rent to the NHS over 30 years. In answer to a question posed by a deputy in the Chamber of Commons the government revealed that the actual cost of the PPP's in the NHS was 45 million pounds during 2006. In many countries it is the regionalization of the healthcare sector that leads to waves of privatizations. This is particularly true in Italy and Spain. What is happening in the area of social security? It is said there is a deficit in the social security funds. The reasons given are the following: aging of the population, an excess of prescriptions given by doctors, and excess of 'consumption' on the part of the insured, expensive retirement systems and privileges given to certain categories of employees. The tone is set by the Central European Bank that sums up the objectives of the European Union in its monthly newsletter of April 2003: "The increase in the age of the population will have a considerable impact on the economies of the euro zone. The public expenditure on healthcare and long term care will increase and the demand for technical progress in medicine must increase in accordance with the aging of the population. The slowing down, and consequent reversal in the tendency to hire seniors, exerts a negative pressure on economic growth. It is necessary to rapidly set up reforms in order to handle aging of the population. These reforms must render public pension systems financially viable as well as arrangements for healthcare and long term care by limiting the exposure of the public sector and make private insurance more accessible." The solution proposed is the same everywhere: one must economize. How? By reducing the cost of labor, that is to say: By increasing the age of retirement and by splitting up retirement systems; by suppressing monopolies and allowing social security to become a market product; by increasing the number and amount of expenditures to be paid by patients, developing self-medication and generalizing recourse to generic medications. Firstly, I think it is indispensable to establish the truth: there isn't a deficit in social security funds. It is the exemption from employer contributions and the funding measures taken for social security systems that empty the social security coffers. In France, exemptions from contributions given employers rose to 175 million euros during 1991-2005. The draft of the law funding social security for 2007 foresees the suppression of 2.1% of contributions for social security for minimum wage earners in companies with fewer than 20 employees. During 2005, employers pocketed 23, 6 million euros in exemptions from contributions. In Germany, new employer exemptions are expected by the 'reform' of healthcare voted by the Bundenstag last February. In Italy, the cost of healthcare was borne up until 1966 by the "obligatory contribution to national healthcare" paid by employees on the one hand and the employers on the other. In 1996 the first Prodi government suppressed this contribution and replaced it by a tax calculated on a regional basis, the objective being to reduce employer contributions. The exemptions for employer contributions rose to 9 million euros a year in Italy, and 6 million euros a year in Belgium. In Hungary, the government reduced by several million florints its contribution to healthcare funds (social security is in the hands of the state in Hungary.) In Romania, the offensive took the form of taxation of health insurance. Up until 1999 medical assistance was free. Later the government introduced private social insurance and in 2002, the National Health Insurance Fund (CNAS) came under the control of the health minister which allowed the government to detour budgets assigned to healthcare towards other sectors. The funds allotted for the health insurance for medication are usually exhausted by the first days of the month. The insured have to pay for their own medications. In turkey, the Social Insurance Institute (IAS) which offered free health services to the population is now under the control of the health minister. This opened the way to privatization of numerous services. Where does this pillage come from that squanders social security funds to the detriment of the right to care? Doesn't it have a connection with the European Union and its integrated directive lines? The integrated directive line No. 15 says: "The member states must reinforce the measures for economic incentive including a simplification of the tax systems and a reduction in the non-wage costs of labor." The pillage organised by the European Union: Here are some of the consequences of this organized pillage: The first is the set back of all retirement systems through spreading and the increase in the age of retirement. At the Barcelona summit in March 2002 it indicated its conclusions in point 32: "by 2010 one must have progressively increased the effective average age of retirement in the European Union." By applying the Barcelona summit throughout Europe governments have increased the age for retirement. In France, in 2003 the Fillon counter reform lengthened retirement age (from 37.5 annuities to 40 annuities for civil servants, 41 then 42 annuities for private employees.) In Germany, the age for retirement was increased to 67 years by a vote in the Bundenstag. In Hungary, the age for retirement was pushed back to 65 years in a country where the amount of a pension is very low and consequently retirees are forced to continue working. In Denmark, retirement age will increase from 65 to 67 years. In Turkey, the recently voted reform of social security has permitted an increase in the age for retirement. We could cite other consequences such as the development of self-medication, generic medication, the increase of hospital rates in France or the increase in the health ticket in Italy, or the establishment of supplementary fees in hospital in Belgium, or the increase in contributions by wage earners in Hungary, or the introduction of supplementary costs not covered by public healthcare insurance in Romania, etc. This must be linked to the report of the European Commission on social protection and inclusion, published on February 19, 2007 that requires "the fixing of general ceilings for expenditures, the participation (of patients) to the cost of services." Suppression of the monopoly of social security systems I must end this presentation with an important question: the suppression of the monopoly of social security systems In France, they encourage patients to pay for supplementary insurance. At the same time certain activities covered by social security funds are out-sourced: for example the healthcare charts are processed by private companies. In Romania and Turkey, private insurance companies are developing. This corresponds to the implementation of resolution 2000/2009 of the European parliament aimed at "offering supplementary insurances a wider role in the internal market in covering risks for different illnesses." On September 26, 2006 the European Commission published a communication on healthcare services, launching a "public consultation". Based on the results of this 'consultation' the European Commission must propose a "healthcare" directive. The communication while calling for "respect and responsibility from the member states in the matter of healthcare services and medical attention," indicated: "The Justice Court declared that this disposition did not exclude the possibility of imposing on the member states adaptations to their national system of social security, as concerns other dispositions in the treaty such as article 49 CE." Article 49 CE stipulates: "The restrictions to the free offering of services in communes is forbidden." The national social security systems would be directly overturned by this European directive.
Speeches made by delegates to the conference Klaus Schuller (member of the labor commission of the SPD in Thuringia, trade union secretary of the DGB, Germany) Dear comrades, the healthcare reform adopted in Germany was rejected by 80% of the population. It is not a reform of the healthcare system, it is its destruction. Against competent advice from all organizations, hospitals, patients, doctors and politicians specializing in healthcare, the grand coalition (CDU/CSU and SPD) passed this monster officially baptized as the "Law for the reinforcement of competition in legal medical insurance" in order to save itself. What has this to do with democracy when laws that have only one objective are adopted against us the workers: the dictates of the European Union and economic circles that want to get rid of solidarity and chop up the social security systems? The merciless profitability of hospitals will lead to a massive deterioration in healthcare for our workers, by the reduction in the number of cases treated and the length of hospital stays. Politicians do not know how children will be covered by medical insurance. We, the workers, furnish 16 million supplementary euros. Here is the crown of this reform: if one abstains from visiting a doctor for one year, the medical fund will refund up to 600 euros. The insured could, like in automobile insurance, choose total or partial coverage then the health fund would give back money. This way we separate the sick from the healthy and the system of solidarity which has proven itself and parity are consciously demolished. There is only one way: we must return to a united healthcare insurance. In a stand taken by the Ver.di trade union in the Berlin district, it said: "Ver.di Berlin contests the right of the European Union's Commission to destroy the right to work conquered in their respective national frameworks by the workers, their trade unions and their political parties as it contests the right to overturn the legality of ILO Conventions ratified by European governments." I am sure that we, hospital personnel, unionists and workers from different European countries will know how to defend the public healthcare system against the destructive policy of the European Union. Thank you. Violeta Tudor (unionist, Romania) Dear friends, we are accustomed to consider health as a problem of public interest. The health of a nation depends on the health of its members. The first concern in this sense would be free access without obstacles to medical services. This has benefited us for several dozen years in Romania. It was one of the big conquests obtained after WW2. This continued after the 1989 revolution for ten years. Up to January 1, 1999, medical care was free. After this date, and several years of groping around the reform of the system, healthcare insurance was introduced in Romania. On the pretext that we have too many hospital beds (in conditions where patients shared one bed) the reduction in the number of beds continued and some hospitals or some sections of them were completely liquidated. It was argued that in the European Union there is an average of 4.2 beds per 100 inhabitants while in Romania the average if 7.2 beds. Are there too many beds? No, this is just a ruse to reduce the amount allotted to hospitals. We will not go into the ambulance system which is even more deregulated. The present health minister, Eugene Nicolescu, has decidedly pushed the 'reform' of the healthcare system since his appointment, proposing the generalization of the private healthcare system as concerns the institutional framework where he insist on the development of private healthcare insurance as well as for medical services. Only emergency services will remain property of the state. Therefore, outside of emergency hospitals (one per department) all the rest will be privatized. Out of 450 hospitals only 50 will remain state property. Self medication in Romania is around 80%. Home births are more frequent. Medical reports indicate that every two or three days young women from urban or rural areas arrive saying they have given birth at home or in an ambulance. "Why are we in the European Union?" asks Elena Rajnita, a gynecologist and spokesperson for the hospital in Olt. At the same time, luxury suites are set up in hospitals, for those who have plenty of money. The reduction in budgetary expenses affects the healthcare system in various ways. For example if the medical techniques are outdated, the wages are low, and hospital personnel is insufficient. Often patients can only obtain medications if they buy them (a fact known to the health minister), and accommodations and meals are unbearable. Patients often leave the hospital before they are well because of the miserable conditions. Periodically the health minister revises the list of free or subsidized medications and reduces their number. In February 2007, they even removed from the list antibiotics for children, which used to be free. The public ambulance services has been reduced and about to be suppressed. It is partially replaced by private or semi-private ambulance services. Not only has there been a decrease in hospital beds, but some hospitals have been closed. Even medical specialties have bee reduced such as genetics. The geneticists in Cluj decided to send a petition to the European Commission in an attempt to impede an order by the health minister in which genetics was taken off the list of specialties that resident doctors can practice. The draft for the modification of the Hospital Law is criticized by most directors of health centers. Many managers of health centers are contesting the transformation of hospitals into shareholder companies in order to relieve their debts and create a hospital network. "If we only have private medicine those who have money will be cared for, but the others will die," declared Dr. Alexandru Ciocalteu, director of the Sf.Ion Hospital in Bucharest. On the other hand, privatization of hospitals will automatically mean the destruction of trade unions and will force many people into unemployment. It is not surprising that the leaders of the SANITAS federation and Health Unity are skeptical about this proposal. According to the president of SANITAS, Marius Petcu, privatization of hospitals will limit the access of the poor to medical services. "It is not the best solution. It is a liberal variant of the present government. The intention is to control the system in which a lot of money circulates. No one privatizes for the love of social security. They will introduce a selection system: fewer personnel but better paid. In a country with a poor population, access to private hospitals is limited. For example the Euroclinic Hospital. It doesn't work. No one wants to pay for services already paid for by insurance. To privatize all hospitals is not a reasonable initiative." The 'reform' of healthcare proposes to close hospitals. Here are some declarations by union leaders in the department of Dolj, on the closure of the Poiana Mare Hospital: "People were dismayed. We received messages of encouragement from all SANITAS affiliates in Oltenie. Throughout the night I received threatening messages warning us that if we did not give up we would be shot down with rubber bullets. These messages stopped when we took over the local police station," declared Ileana Ionescu, president of the SANITAS affiliate in Dolj. According to the union leader the employees of the Neuropsychiatry Hospital of Poiana Mare, Marcela Ticu, all the 300 employees would resign if they did not stop the closure of the hospital. The safeguard of our generation depends on the resistance which we will prove when faced by physical oppression.
Over the past 20 years in Belgium we have seen a change in operations, in reimbursement for healthcare and medication. Certain problems no longer require operations or only for children and those over 50 years of age. Employer contributions have been reduced which causes a problem for budgets and a decrease in public funds. There is also a problem with supplementary insurance offered by mutual insurance companies. The European Union considers that the mutual insurance companies compete with private insurance companies, in application of the budgetary rules dictated by the European Union. Regarding the destruction of public hospitals: in Belgium in 1971, there were 50% public hospitals and 50% private hospitals. The status of civil servants has been modified. The consequence is that the personnel is no longer a civil servant, but goes through scaled employment contracts with a private pension and the same rights as in private industry. Today there are only 25% public hospitals in Belgium with regional differences after Belgium was federalized. In Flanders, there are no more public hospitals. The last two hospitals remaining became ASBL (Non-profit Associations). Personnel was attached to the CPAS (Public Center for Social Service) in towns and villages. In Walloon, most hospitals became intercommunal (private-public). In Brussels, the hospitals remain public but the personnel are no longer civil servants but workers with scaled contracts, pensions and the same rights as in private industry. One third of hospitals are public, one third are mixed and one third are private. In Belgium all hospitals with less than 180 beds have been eliminated or absorbed by larger hospitals. Rest homes and homes offering nursing care have been opened in order to camouflage the geriatric system (less costly). One of the greatest problems in Belgium is the lack of qualified nursing staff (more or less 25%). The destruction of healthcare and the public service is increasing in Belgium. Gerard Schivardi, (mayor, France) Ladies and gentlemen, doctors, hospital personnel, hospital unionists, dear friends: We the mayors of the small communes have received the mandate of the population who elected us to represent and defend their living conditions and improve them if possible. We have a problem finding doctors because of the numerous clauses that limit the training of doctors. We have the problem of the closure of local maternity wards. A colleague of mine reported on the difficult time a mother had while giving birth in a parking lot because the maternity ward in Amboise had been closed. After meeting with my colleagues in Pyrenees Orientales, I learned of the closure of the maternity war in Prades. Future mothers are now forced to travel 80 kms to give birth. Women who have difficult pregnancies are in danger as well as their babies. We are told that the small maternity wards that handle less than 400 births a year are a danger to future mothers and that is why they are being merged. But a maternity ward in a suburb of Paris that handles 3,000 births a year has been closed. It is therefore not a matter of security but an economic problem. They close the local maternity wards and hospitals in order to reduce public expenditures to a level authorized by the Stability Pact and the Maastricht Treaty, that is to say the reduction of the public deficit to under 3% of the PIB. At the same time companies relieved of their social obligations are announcing record profits. Economies in healthcare dictated by the Stability Pact, place the lives of women and their babies in danger. On the other hand, exemption from social contributions by companies in the name of article 87 of the Maastricht Treaty that wants "free and unfettered competition." We, the mayors, do not accept the overturn of the right to healthcare and that the state withdraw from its responsibilities because the Commission in Brussels says: "One must decrease healthcare expenditures." This is why we say: "Break with the European Union, break with the Stability Pact, break with Maastricht." We, the mayors, are attached to the Republic that demands equality in right for citizens, and therefore equality of access to healthcare throughout the territory. That is why we say: "We must reopen the emergency services and local maternity wards." My colleagues have designated me to pose the problems in France before the entire country on the occasion of the presidential election., Despite the fact we are confronted by enormous difficulties so that our candidacy can address all citizens, we intend to say: "It is possible to save social security by giving it the 175 millions that were stolen through employer exemptions. It is possible to stop the destruction of hospitals. In order to obtain this we must break with the Stability Pact, the Maastricht Treaty and the European Union and all its institutions." Recently a journalist asked me: "Do you want France to get out of Europe?" I told him I did not see how France could detach itself from the continent. On the contrary I wanted to build a free Europe for free peoples and nations whose base would be the satisfaction of the needs of our population. Aren't we trying to defend in each country the rights of each woman, each child, and each man to be cared for regardless of his fortune, the place he inhabits or the language or color of his skin? You can count on us the mayors, along with the inhabitants of our communes. We will always be at your side, with you the doctors, nurses, aides, hospital personnel, the unionists that believe we have the responsibility to leave to our children in each of our countries, the means to combat and conquer illness. We act for the break with the European Union. We act for a free Europe and the free peoples of Europe. The free union of the free peoples for the defense of our hospitals and our maternity wards can only be achieved in fighting for the break with the European Union. Thank you. Fulvio Aurora (member of Democratic Medicine and leader for healthcare of the Communist Refoundation, Italy) I believe the healthcare situation in Italy is like that of other European countries. In Italy we have a national healthcare system that was modified in 2000 and has become a regional healthcare system. Today we can say there are 28 different healthcare systems. Each region has its differences but one can say there are two different healthcare organizations: one in the northern part of the country near northern European countries and a different one in the South. One must also underline the difference in the level of healthcare since it must serve to improve the health of the population and its workers. If there has been an increase in life expectancy throughout Europe, in Northern Italy the epidemiological conditions are better than in the south, there is a great increase in cancers from north to south. There is also a similarity in the level of working and environmental conditions. I believe we should think about what we can do to avoid the privatization of healthcare, since this leads to an increase in costs, following the medical costs (the price of doctor visits, lab exams, etc.) without necessarily improving care. Generally in Italy there is a resistance on the local level (especially when a hospital is about to be closed). We have tried numerous times to launch national fights but they have not led anywhere. The trade unions have led fights against the part time status of healthcare personnel and against the reduction in wages. The problem is how to act together on a European level if we see that we have common problems. What can we do to stop this drift, in order to fight for Tony Richardson (trade unionist , Britain ) Good afternoon delegates; my name is Tony Richardson, I live in Wakefield, Northern England. I am an activist, Branch secretary of the Wakefield L.P and Vice President of Wakefield TUC and Bakers Union; our Union operates mainly in the Food industry, I work in the bread sector. You may well ask why a representative of a Private sector Union is taking part in this demonstration and fight for Public Services. The answer is simple: my members across Britain access all Public Services and, of them, none can be more important than health; we as a trade Union act on behalf of our members and, therefore, defending Public Services is also defending our members' rights. It is indeed shocking and very obvious that there is now a major thrust across Europe to slowly eat away at the fabric of National Health systems in response to the terms of the Maastricht Treaty, the rush to generate "Services of General Interest"… In Britain, the charge is being led by the "New Labour" government of Tony Blair, which is particularly hard to swallow by the vast numbers of grass roots members and activists, like myself, who see our party being continually pulled to the right. Example after example of closures, consolidations, PFI (Private Financing Initiatives) and Partnerships, small scale contracting out of services & large-scale policy changes are showing that the National Health Service in Britain is slowly but stealthily being privatised before our very eyes. It is quite obvious that Blair and his accomplices are following the
European blue print and perniciously moving Health provision into the
private sector. Possibly, this may be a position we could & should support… but we ask who is best placed to provide "people centred" services, the profit hungry private sector with all that that would bring in terms of profit before people; or the dedicated excellence of a publicly run organisation, with dedicated, experienced staff? Yes, we call for Investment in excellence; No to the attack on jobs & services, A prime example of how privateers work in the NHS was shown by the
private equity firm 3i who, in order to help its poor stock market performance,will
use its PFI asset stake in the Norfolk & Norwich District Hospital
as a lever. In Wakefield, we are at present suffering a long and drawn out Hospital
reorganisation; it will be an amalgamation of 3 Hospitals over a distance
of approx. 30 miles and it will serve a population of 500,000 people;
we have already seen Maternity services removed and consolidated at
one site and more is to come; beds have been continually lost and services
spread around the 3 sites. During my period as Chair of the Scrutiny Committee, I always ensured
that our reports told the true story of how services were being lost
in Wakefield; a prime example was the loss of services for the elderly
where now almost 80% of elderly people's homes & nursing homes are
now provided by the private sector. THAT IS THE ICEBERG THAT THE PEOPLE
DO NOT SEE …. They are the threats we face,They are real,They are local,They affect ordinary citizens,They affect my members. It is now we need to act It is now we need to fight to get the message across, or it will be too late. That is why I am taking part in this conference; there has been excellent action taken by the Trade Unions in Britain, in defence of the NHS; we as activists have a duty to continue that action, get the message across, and save all Europe's Health Services.
I work in Social Security. At a meeting, Dr. Guerin, president of the
Association for the Defense of the Code of Ethics and the Rights of
Patients, said that Social Security constitutes "a veritable unity
among all the French." He is right. This 1945 conquest changed
everyone's' lives. Must we give it up since it is incompatible with
the European Union? Regardless of what country, attacks are increasing
on the financing system for healthcare and social security. Antonio Herranz (healthcare unionist, Switzerland) My name is Antonio Herranza and a unionist in the healthcare sector. Switzerland is not part of the European Union but the European Union is very interested in Switzerland especially in the area of liberalization and privatization of the healthcare system. An OECD report criticizes healthcare expenditures in Switzerland and ask for more competition followed by a report on state service to the economy (SECO) matched to a comparative report on liberalization of services in Switzerland and the European Union. The conclusions conform to what is happening in the rest of Europe: privatizations, more competition, creation of inter-cantonal hospitals far from all conventional systems, self-medication, closure of zone hospitals and maternity wards. Immediately after this report, the federal council drafted a reform to the law on financing that requires equal financing for public and private hospitals.(Lafu). This policy is accompanied by the destruction of collective bargaining, statutes that lead to mistreatment in particular in homes for the aged and chronically ill. In Switzerland, one of the richest countries on the planet, since January 1, 2006 when the reform of medical insurance went into effect, over 120,000 people out of a total population of 7.5 million were no longer covered for medical insurance. This situation has become catastrophic for many workers' families. Thank you. I cede my place for further discussion since what is important is to know what we can do together. Fatih Artvinli (Health an Social Services Employees' Union For the last 20 years, the Turkish society has been imposed a schedule
through which steps are being taken completely for commercializing the
health sector. The Hospitals under the auspices of the Ministry of Health, increase
their expenditures on medical supplies from the private medical industry.
The providers of public health such as State Hospitals, University Hospitals
and Social Insurance Institution hospitals, transferred the auxiliary
services to the private market. Sanitizing, security and laboratory
services were among these services. The discourse of these changes is built on the basis of decentralization
and privatization. After deconstruction public health services, they
are planning to autonomize the health units. Autonomization process
includes the transformation of decision making mechanism and the acceleration
of privatization. In this respect, privatization process began with
the deformation of public health services. Now let us look at the structural changes in health policy in three
steps: The first step was the transfer of the ownership of Social Insurance
Institution (SSK) hospitals to the Ministry of Health. This was a step
towards setting up an health insurance system which gathered all health
insurance tasks under a single umbrella. These tasks previously belonged
to different social security institutions. The SSK was an institution
which delivered low-cost services to a large mass of people (private
sector employees and blue-collar workers of the public sector were benefiting
from SSK hospitals). Then civil servants were given the "opportunity" to benefit from private health services. In this process, the government began to exploit the long-established image of "good private hospitals versus bad public hospitals". In this context, there has been a serious transfer of resources to the private sector. The crucial point in this process is that, the civil servants have had to pay higher fees exceeding their personal budgets to reach "higher quality" medical services. Because the contributions of the state to their health expenditures was limited. Performance-based System The second step of reform was the introduction of performance-based
remuneration system in all institutions attached to the Ministry of
Health through a directive on extra payments from revolving funds. Family Health Care System The third step is the family health care system which was imposed by IMF and World Bank. Family physician project is being implemented in nine cities now. The family health care system lays the ground for a competitive environment where physicians will deliver their services while upholding their concerns for "keeping clients"… Family physician system offers only one doctor per 4,000 people. However in the public Health Office system, there must be an office per 1,000 people. For the number of people between 1,000 and 5000, the government must open a larger public health office. This system served more qualified preventive health services to the people. In this system, vaccination services were distributed more fairly and free. Since the implementation of the family health care system, public health
care offices serving preventive health services were started to be closed
down. If it is insisted to implement this system, preventive health
care system will gradually collapse. As the health service will be given
by just one doctor and one nurse, the home visits, the monitoring of
the pregnants-babies and children will not be continued and the percentages
of vaccination will gradually decrease. Social Security Reform Another implementation about health policy is Social Security Reform.
The basic arrangements of the reform aim to reduce the contributions
of the state in social security. Some of these arrangements are, the
reduction in pension salaries, the increase of the age of retirement
and the increase of payments in health services. Social Security Reform
is also bringing many changes against employees and needy people. Instead
of providing social security funding from national budget which is composed
of taxes due to individuals' income, it is approved to provide social
security service according to the basis of premium. For employees to
retire, the payment level of premium will be gradually increased from
7,000 days to 9,000 days. More than 60% of labouring men in Turkey are
unregistered employees, and Turkey is one of the countries where inequality
of income distribution is among the highest in the world. Unfortunately,
our country is getting ready to sacrifice from social security in the
name of social security reform. Just like the other European countries, the public hospitals in Turkey
are first transformed to more autonomous enterprises; then completely
privatized. Some of the public hospitals by the way are directly closed
down. As the most active and revolutionary health and social services union in Turkey, we are trying to organize an oppositional political atmosphere in this environment. Having nearly 40,000 revolutionary members, we feel that we can develop new resistance strategies against neoliberal attacks. Since the beginning of the deconstructive health system process, we organized lots of meetings in local and national scales, prepared lots of brochures and pamphlets that clearly explain the effects of the neoliberal health reform on the poor and the future employment situation of the health personnel in this reform and what can be done against this reform. The people are complaining more and the resistance is increasing as the effects of the transformation of health programme become more visible. A series of protests called "White Protests" organized by TTB and SES continued throughout March. The most enthusiastic among these was the demonstrations of "White Task" made on the Health Fest of 14 March. A simultaneous one-day strike was organized in all the big cities. The interest, support and the flame of enthusiasm among the people towards the demonstration of ten thousands of health workers were very significant developments. The demonstration of "Stop the Destruction in Health" will continue till the coming election. Much more support and organizational activity are required to stop this destruction. If the Labor Platform continues to work more actively, we will have taken a great distance on the road to win our health rights and stop the destruction. Joaquin Insausti Valdivia (doctor, Spain) It has now been two years since the workers at a small hospital in Madrid, Hospital Severo Ochoa, are the victims of harassment by the health secretariat in Madrid, which was appointed by the Popular Party. Councilor Manuel Lamela, accused the coordinator for emergency services and the doctors that work there of having committed 400 homicides through irregular anesthetics, following an anonymous complaint which had been discarded by its own inspectors since they did not discover any irregularities. Several inquiry commissions, named by the Secretariat and others by the college of doctors in order to justify the activities of the councilor. Finally the councilor denounced five emergency doctors accusing them of homicide and laid off five heads of services and three supervisors, who had demonstrated against these activities and at present a judicial inquiry is open, which will take its time in order not to render conclusions before the municipal elections next May 27. During these two years the workers at Severo Ochoa, the major trade unions and the citizens of Leganes have demonstrated in the streets several times, asking for the resignation of the health councilor and restitution of the reputation and know-how of the Severo Ochoa Hospital. Two years in which the workers at the hospital meet every week at the doors of the hospital to demand the resignation of Lamela and the reestablishment of the rights of the personnel who are victims of this repression. The question of the situation of healthcare in Spain lies behind these facts. The expertise in care and sanitary planning were transferred from the state administration to the autonomous communities. This transfer has meant big changes in care, in remunerations and working conditions in each autonomous territory. Differences that are instigated by state and European policy of budgetary restrictions that is presently materialized by the healthcare financing pact recently passed by the Zapatero government and the autonomies. This pact is opposed to what the Socialist Party recommended which considered that an injection of six million euros into public healthcare was necessary. This, in a general fashion, is how privatization of sanitary services works, with the pretext of "reducing waiting lists" and other times placing the management and construction of new hospitals in the hands of consortiums, insurance companies, banks and building companies. Fabricated scandals such as the one at Severo Ochoa tend to discredit the work of public medicine and its professionals, in order to glorify the excellence of private medicine as an ideal solution to healthcare problems, the usual derailment of financial means and the loss of control of management by public medicine. The national healthcare systems and public health are in danger of extinction, which may leave large sections of the population in a precarious situation. This is why we ask at this meeting: We must affirm that the European Commission is responsible for these policies of zero deficit, including the Maastricht Treaty, obliging healthcare systems to reduce their expenses in order to fulfill their conditions, making privatizations paint a horizon of restrictions, in benefits and other measures that could lead to the absence of care for certain groups of the population. We must launch an appeal to the citizens, to the workers and to the trade unions throughout Europe so that they mobilize for the purpose of defending public healthcare and all national systems of healthcare that are society's gain, and put a stop to privatization maneuvers that are in route in numerous member states.
I am the leader of the Ver.di trade union of the hospital group VKKD in Dusseldorf, a group that employs 2,500 workers and has 1,500 beds. This group belongs to the Catholic Church. After the deputies-those artists under the dome of the Reichstag-voted the healthcare reform on February 2. It was after this vote that 30 SPD deputies did not follow orders of the leaders of their party. The criteria of Maastricht is applied which means: A decrease in employer contributions, a decrease in differed wages and even more serious, a patient must prove he looks after himself: a smoker no longer has the right to have cancer, an athlete cannot break a leg, and the chronically ill are severely penalized. The president of the German chamber of doctors, Hoppe, declared: "In this country the poor die seven years earlier." At the same time the attacks continue: ? After a study by the McKinsey group in 2006, one third of the 2,000 clinics were threatened with closure. ? In 2007 a study by the RWI, an employers' institute, established that 40% of hospitals were threatened with bankruptcy now through 2020. According to them this could be avoided with new cuts in costs and the introduction of market logistics in the hospital sector. Despite this, one out of five hospitals should close by 2020. ? Out of 2,400 hospitals in 1989, there are now only 2,050. They have closed 350 hospitals since 1989. ? Since 1989 there are 16,000 fewer beds (equivalent to the number of inhabitants in town like Grenoble, Leverkusen, Perugia, Getafe, Aalborg, Amadora and Salamanca). Privately financed hospitals have increased over the years. According to national statistics in 1991, it rose to 14,8% and now in 2006 it is u to33%. In purchased hospitals, they want to make 20% profits. This means that 20% of our contributions to medical insurance funds go into the pockets of the shareholders. At present, there are around 250 funds, with 28 million members who contribute and around 40 million members insured for free by the others. Even the large groups of private hospitals are in trouble. When companies such as Sana, Rhon or Asklepios are under pressure, we can imagine what happens to the others. The consequences are lengthy periods for getting appointments since the hospitals will concentrate on the clients who can pay and lower the quality as much as possible for those nominally insured. There are 460 hospitals in Rehnanie du Nord Westphalie, of which 320 are Christian (without collective bargaining as in other hospitals). Over 40% of hospital managers were laid off last year. All public clinics (LBK) in Hamburg-with 12,400 employees in Hanover and neighboring towns, were sold. "Community of service.": this word first appeared in 1938! It was used to justify the banning of trade unions. Today it is promoted in religious and social institutions in Germany. They want the "third way" without the same rights, without strikes, without trade unions. After attempting to lower the wages in Protestant hospitals by 20%, there was the first strike since 1919 at six Christian hospitals in Stuttgart, in March of this year. Last year there was a strike lasting 19 weeks in German university hospitals in order to impose collective bargaining. The SPD must break with the grand coalition! The SPD must break with the leaders of the party that practice a policy of destruction! Break with Maastricht! Break with the European Union!
To day I thank the Belgians for this initiative. I represent to day the People's movement against the EU, our trade
union comittee. In my daily life I work in a hospitals where I am shop
steward. User payment and responsibility Increased competition A good reason for us to join in the fight against EU with you.
Dear comrades, we cannot talk about attacks against public healthcare systems without referring to social security systems. From this point of view, the report and speeches that preceded me, have placed in evidence the common traits of the set back of the mission and place of public hospitals. All the blows struck take us back to The European Union, its treaty and its directives. At the center are the constraints of the Stability Pact and the lowering of public expenditures (Maastricht criteria). All governments are undertaking a reduction in expenditures to our social security systems. Whatever the variants noted in the different member states of the European Union, were are present at new withdrawals of obligatory systems, new transfers on households and their dependents in order to respect the balanced budgets and reduce public expenditure dictated by Brussels. The present debate in France on self-medication is included in the process. We must stop doctors from taking cuts on prescriptions that are reimbursed by social security. A Frenchman consumes around 20 euros of self-medication a year against 50 euros in Spain and 60 euros in Germany. For the French government "self-medication represents a potential economy superior to that of generic medications!" In France the financing of hospitals represent half of the social security budget. After Juppe's regulation of April 1996, the following governments completed the supervision of expenses through financing laws and their closed envelopes, in order to accelerate restructuring and economic plans imposed on hospitals. As for public hospitals more recently, the plan "Hospital 2007" is in operation along with the "new governance" of hospitals. It is about the government involving professionals, personnel leaders in the choice of "medical-economics". In the framework of a closed envelope, in the name of the principle of subsidiarity, these choices will be the consequence of the fixed objectives of "objective contracts" prescribed by the directors of hospitals and the Regional Alliance for Hospitalization, then between the directors and the professionals. The defense of the independence of health care professionals and their trade union organizations is a burning issue. As in other countries, France has not escaped regionalization of its healthcare system (implemented by the Regional Hospitalization Agencies, regional healthcare organization, and development of cooperative private/public healthcare groups setting back the equality in access to care. We see the development of privatization of public services, especially the public-private partnerships (PPP) inspired by the "Private Finance Initiative" as comrade Tony Richardson explained. There are around 30 hospital projects in course in France. We must recall directive 2004/18/CE of March 31, 2004 that introduced the conditions for transfer of markets that must respect free circulation, the freedom of establishment, the free offering of service and effective competition in public markets. This directive was the basis for the regulation of June 15, 2004 organizing public/private partnerships in France. It is in this context that the European Health Commissioner, Markoz Kyprianou, recently declared that "competition among European health services is inevitable." In order to reply to the demand of the European Commission, his intention was to present at the end of 2007, a draft of a directive to regulate the offer healthcare service across frontiers. I will not go over the facts and figures brought up in the introductory report that shows the scope of the damage to our healthcare systems. The reduction in costs for healthcare has evidently, consequences on the access to care for patients because of restructures, closures of beds, services , hospitals and maternity wards. But this also has a consequence on the personnel such as their status and collective bargaining. In our public hospitals, 72% of the budget represents the wages of medical and non-medical personnel. We see where the economies must be made. We must do without the judicial frameworks that provided collective guarantees to all healthcare workers. We see that parallel to the privatization of hospital services, it is the privatization of hospital workers' rights, by the overturn of the public function statue because of the European directives. Many have asked what can we do and how? Firstly we are all here: doctors, hospital workers, trade union leaders and activists, and it is natural for us to fight with our organizations in order to defend public services and, in particular, our hospitals, the personnel statute and through them, the patients. We must continue the fight in every country, in order to preserve the collective rights and to organize resistance against all government plans that want to impose on us under pressure from Brussels. Thank you. Marie-Paule Lemonnier (doctor, France) I would like to present the contribution written by Professor F. Guerin for this meeting. "Who could have imagined that in 1998 France, classed in first place in the world for its healthcare system by the WHO, would find itself eight years later in its present situation? All the 'reforms' undertaking over the years have provoked a progressive degradation of the healthcare system reputed to be the best and all healthcare professionals are in agreement with the following facts: 1. First a considerable decrease in the offer of care, such as the suppression of a third of hospital beds, the closure of half the maternity wards and the drastic limitation on healthcare expenditures vote in by parliament each year. This decrease in the offer of care have as its consequence the appearance of waiting lists for certain surgical operations and for certain treatments such as for cancer. 2. Increasing difficulties for patients of modest means to access care, which they need because of the heavy financial charges at hospitals or local clinics (1 euro for each visit and for each medical performance, 18 euros to services that cost over 81 euros, a tax of 16 euros for each day of hospitalization, only 70% reimbursed instead of 100% as before, of all post-operative care performed after r release from hospital.) 3. A lack of doctors, already evident but will increase over the next 15 years, because of the Malthusian policy of successive governments, whether of the right or the left, concerning the number of doctors trained in the medical faculties of our country (3,500 between 1992 and 2,000 against 8,500 in 1972.) This policy of rationing care has dramatic consequences that doctors and nurses observe every day: A hospital doctor testified at a press conference organized by the Medical Association in Defense of the Code of Ethics and the Rights of Patients (AMDDDM) last February 13, that in the emergency service of a large Parisian hospital, "50 patients were shoved onto benches only 20cms wide" and doctors searched in vain for beds to accommodate them. Another hospital doctor, head of a pediatric resuscitation unit complained that there were only three doctors instead of the seven required for the proper functioning of the unit and that they lacked 20% more nurses. This same doctor protested against the fact that the administration asked them, in an arbitrary fashion, to lower by 5% the number of biology tests and X-rays performed at the bedside. A third doctor, head of an emergency service and pediatric resuscitation indicated that for lack of doctors, 5,000 full time jobs and 2,500 part time jobs were not covered in French public hospitals. He also commented on the fact that only 200 pediatricians are trained instead of the 600 judged necessary in that specialty. A village doctor testified on the dramatic situation of his specialty. A decrease of 40% in the number of psychiatrists is foreseen from now through 2015, while already 700 hospital psychiatric jobs are not provided because of the lack of doctors. Furthermore, "45,000 to 50,000 handicapped children in France have nowhere to go" and "over 100,000 adults have nowhere to go because the have closed 55,000 psychiatric beds over the past 30 years." All the testimonies and many others we could cite agree in demonstrating up to what point the recent "reforms" have altered the quality of medicine in France and rationed care. We must question the reasons that have led the policies of our country
to destroy what was until recently the pride and honor of France and
we are forced to understand that it is the directives and European recommendations
that have over the past four year incited public powers to strictly
limit healthcare expenditures. In its recommendation of September 26, 2006, the European Commission foresaw "imposing on member states adaptations to their national social security systems in view of other dispositions of the treaty (Maastricht) as in article 49." Article 49 stipulates, "the restrictions on the free offer of services within the Community are forbidden,", which could mean that the monopoly of the social security system that has allowed the unity of all French peoples since 1945, could be suppressed and we have already seen some French people who anticipate this evolution and who, in refusing to contribute to social security are subscribing to private insurance.
Dominque Vincenot (European Workers Liaison Committee) Dear comrades, do we exaggerate when we speak of "the accelerated destruction of public healthcare systems throughout Europe?" The 15 doctors, hospital unionists and activists who have participated in the discussion replied to this question by providing testimony and precise documentation on the state of public healthcare in their countries. All testimonies showed that the setback of healthcare systems and social security pose a question of life or death. We heard from comrade Klaus Schuller, leader of the DGB trade union in Land of Thuringen, and vice president of the labor commission of the SPD in Thuringen, explain that from now on a premium of 600 euros will be charged to those who for one year have not seen a doctor or had any medical intervention. We heard from comrade Rudy Janssens, federal secretary of the Brussels region of the CGSP, who explained that in 1971 there were 50% public hospitals and 50% private hospitals. Today there are only 25% public hospitals. The difference in regions is flagrant: in Flanders there are simply no public hospitals. In Walloon most hospitals are mixed public/private companies. We heard from Violeta Tudor in Romania, a SANITAS unionist, who said it is not unusual for patients to be sent home before they are cured because of the awful conditions in the hospitals. We heard from Fatih Artvinli, leader of the trade union for healthcare
and public services, who explained how certain public hospitals have
been simply closed, as is the case of the children's hospital in Istanbul
that cared for around 40,000 children a year was closed because the
number of patients was considered "insufficient." We heard from our friend Gerard Schivardi, who reported on the enormous problems resulting from the closing of maternity wards in the immediate proximities of the patients. We heard him say how one of his colleagues, the mayor of Sarthe, had to assist a young mother in a parking lot because the maternity ward in the neighboring town had been closed and she had to travel 80 kms to give birth. We heard what Tony Richardson from Great Britain told us about the state of healthcare services, decimated through the privatization of the NHS, resulting in the reduction of the number of hospital beds by 20%. We were overwhelmed to hear the testimony of Professor Guerin, president of the Association in defense of the code of ethics and the rights of patients (AMDDDM, France) who read a letter from Dr. Lemonnier reporting on the scandalous conditions in which aged patients, for lack of space, are virtually crammed into waiting rooms, while the doctors and nurses search with anguish for beds to accommodate them. And we listened to what Dr. Joaquin Insausti, member of the Association
for the defense of Severo Ochoa hospital, said about the infamous campaign
that has developed to accuse the doctors for the death of patients,
whereas these deaths are the tragic consequence of the fact that the
doctors are no longer permitted to attend to their patients. Our French comrade Nicole Bernard, a social security unionist, posed the following question: "In France we have experienced an unprecedented attack against our retirement system (reduced to 37.5 years of payment) by the Fillon Law of 2003, following the Balladur measures of 1993. In Germany the age of retirement has been increased to 67 years, in Hungary to 65 years. Is this a simple coincidence, or rather is it not the result of policies decided at the highest levels, that is, by the European Union, and implemented by all governments? It is not enough to affirm this; we can prove it, quoting, as many comrades have done, the specific European Union directives and recommendations> Hence, in relation to the retirement age, was it not the European Union that decided to increase the retirement age when it indicated in its conclusions at the Barcelona Summit in 2002 that: "Beginning here and through to 2010 we must progressively increase by five years, the average age in which professional activity ends in the European Union?" Other comrades exposed the reduction of thousands of hospitals beds,
certain hospitals, and maternity wards. Is this a pure coincidence?
Isn't the closure of millions of beds and complete hospitals the consequence
of the policy of the European Union as advocated at the Summit in Thessalonica
in June 2003, ordering surveillance of the efficiency of measures taken
to unravel the spiral of expenses in the healthcare sector and take
their evolution to a more supportable level?" And this is true as well for countries that are not members of the European, as was explained to us by comrade Fatih Artvinli from Turky, who indicated that the implementation of the plan proposed by the International Monetary Fund, which increases the cost of medication by 60%, is one of the conditions demanded by the European Union for Turkey to be able to join. This brings me to the question asked by Fulvio Aurora from Italy: "So, what can we do for the defense of our healthcare systems in Europe?" Here, as well, I think that the discussion also began to raise some answers. I heard comrade Luc Delrue, hospital unionist from France, recall that we are all here, doctors, hospital workers, trade union activists and officials, and it is natural that we fight together with our organizations to defend our hospitals, the status of personnel and through them, the systems of social protection. And this means therefore fighting to defend our trade union organizations themselves, as they are the instrument for our struggle. I think he is right. This brings us back to what Tony Richardson noted about Great Britain,
where numerous initiatives have been taken by trade union organizations
over the past years, to defend a hospital, and the NHS in general. As comrades Schuller and Mees recalled, the massive 80% rejection by the German people of the "health care reform" led to several SPD MPs in the Bundestag to vote against this counter-reform proposed by the "grand coalition government." This is a struggle not only in defense of what remains but also for the reconquest of all that was liquidated - as civilization itself is at stake. This struggle is not at all contradictory with the struggle on a European level to place the European Commisssion before its responsibilities. I completely agree with what comrade Eva Hallum of Denmark said when she underlined: "We should make the connection between the attacks on our healthcares systems and the policies of the European Union as a whole ." At this conference, some comrades reached the conclusion, which I share, that it is necessary to break with the European Union and its institutions. Other comrades did not reach this conclusion. But I did not hear a single person deny the crushing responsibility of the plans of the European Union, the Stability Pact, and the Maastricht for the disastrous situations facing each of our healthcare systems. Let's return thus to the question posed by the Italian comrade: What can be done to defend our public health care systems in Europe?
Finally, we have all heard the appeal by our Spanish comrades and I am sure each delegation, by whatever means, will answer and transmit its solidarity to the doctors of the Severo Ochoa Hospital against that infamous campaign.
On March 11, 2005, the director of the Madrid Healthcare System, Manuel
Lamela, published and gave credit to an anonymous complaint that accused
the Emergency Services of the Severo Ochoa Hospital, a little hospital
in southern Madrid, of having committed 400 homicides on "cancer
patients, dementia and/or physically handicapped patients or any other
aged patient that might be suffering from a pathological problem,"
without noting that this accusation could only come from an insane person. Today, two years after the start of the conflict, the judge considers the emergency service doctors matter settled since there is no concrete accusation. Apparently, the judgment must be delayed until the next local elections since the Popular Party does not want to pay the bill for Lamela's accusation (he has always been supported by the President of the Community, Esperanza Aguirre). The accusations of the Health Secretary in Madrid have sown a certain amount of confusion among the citizens and allowed the introduction of certain forms of privatization that will not only affect new hospitals, but could extend to those presently dependent on the public system (thanks to the amendments introduced by the Popular Party in the law on budgets in 2007). The other effect of the Lamela scandal, is that we have been set back several years regarding the development of palliative care in general and end of life assistance in particular. This is why we address this appeal to the organizing committee for the March 31 meeting in Brussels and the delegation to the European institutions for the defense of public healthcare systems in Europe: Help us to combat this injustice that affects the Severo Ochoa Hospital and that prepares the dismantling of public healthcare and transfers public funds into private hands. Contact: Secretaria.general.tecnica@salud.madrid.org and jaima.haddad@salud.madrid.org European Workers Liaison Committee Report of the April 2nd 2007 delegation to the European Commission The delegation had been mandated to obtain precise answers to the following
question: "is the defence of our public healthcare and social welfare
systems, and demands to win back what has been lost, compatible with
the European Union and its directives?" on the basis of the memorandum
compiled to prepare the March 31st 2007 meeting and of the facts given
by those who attended the meeting. The delegation - In Every European country, healthcare budget cuts prevail as well
as postponement of the retirement age. - You surely know that, since 2004, we have been ruled by a closed
budget regime. In France, this has led to the 2012 Hospital scheme.
Under this scheme, 5 billion are reduced from hospital funding,
forcing them to restructure. This amount is the equivalent of 60,000
beds or 100,000 hospital jobs. Hospitals are granted less money than
they need to do their job. The first consequence is a systematic and
permanent reduction of the number of days a patient can stay in hospital.
In geriatric wards, bedsore prevention is no longer warranted under
the excuse that patients stay less long. Nurses do not have enough time
to take care of patients. - In Belgium, we are "in the lead". As a result of regionalisation, the two public hospitals that remained in Flanders have been privatised. In the Walloon country, healthcare is taking a backward turn. Throughout the country, fewer and fewer people can afford to have treatments. Philippe Brunet: I should like to bring your attention to a couple
of principles In Brussels there is no guideline tending to favour the private or
the public sector. In some States, private-public partnerships exist
alongside public sector. There has never been a EU level directive favouring
the private sector at the expense of the public sector. The only implementation
directives aim at budget balance and non discrimination.
Philippe Brunet: you should not mix up everything. The delegation: we do not see how bringing down healthcare systems
in Western Europe will improve the situation in Bulgarian or Romanian
hospitals. Besides, a Romanian trade unionist brought concrete facts
at the March 31st meeting. Philippe Brunet: That is not the point. The point is not at all opening new infrastructures. This map should be funded by extra-national budgets. We shall not decide where a scanner will be installed but we will say: "Take the elements that are not national, the flow of people into account"
Philippe Brunet: that is another section. This resorts to social issues. The delegation: 2,000 GPs and healthcare professionals took a stand against the Montchamp law in France. They contend that getting handicapped children out of specialised structures bans them from having access to the treatments and education they are entitled to. What is your answer? Philippe Brunet: a counter example is no proof. If you have a host
of physicians against this measure, then go and call on the French government. The delegation: - What you are saying on rare diseases could be tempting. But, in real
life, we are witnessing a two-tiered medical practise setting in. We
want equal access to treatment. We do not want a patient to be turned
into a customer. Philippe Brunet: you are mentioning the text of the investigation.
At this stage, there is no text. I hope you have put your point of view
in writing as it is to be part of the investigating process we have
organised. The delegation: today, like yesterday to those who are responsible. Philippe Brunet: then, it is the European Union that is responsible? The delegation: the healthcare reform was voted by the German Parliament
in February. The MPs told us: "all these instructions come from
Brussels"
The delegation: are all the countries entitled to have a maternity hospital within a 25 km radius to guarantee the life of women and new-born babies. Philippe Brunet: that is beside the point. The delegation: you are then saying that there is no connection between
macroeconomic indications and material consequences on bed-, ward- and
hospital closures? Philippe Brunet: things cannot be managed as they were back in 1957. Technical progress is such that it brings higher costs that are not sustainable. Advances cannot be managed. One must seek efficiency. The countries of the Asian Zone are reducing costs too and that is not the making of Brussels! It is a challenge that mankind as a whole has to face. The delegation: so then can the budget balance be opposed within the 3% framework? Philippe Brunet: money must be spent in the most efficient way. At
a given time, choices need to be made. The delegation: Mr Brunet, thank you for receiving our delegation.
We ask: is it right or not to affirm that there is a direct connection between the destruction of all the public healthcare services in Europe, and of all the social protection systems, and European directives?
When Mr Brunet affirms: "The Stability pact demands that Member States do not spend money that they do not have…. States can do whatever they want provided they keep deficits under control…. The only thing that European directives impose is fighting public deficits." he pretends that there is no such thing as the recommendations adopted by the June 2003 Thessalonica Summit that urgently press Member States to cut all public expenses, healthcare for one. Meanwhile, he confirms what can be observed in each country: healthcare expenses, just like any other public expenses, are subjected to the rule of excessive deficits imposed by article 104 of the Maastricht Treaty that compels Member States "to avoid excessive deficits". This rule brings about the closure of thousands of beds, thousands of lay-offs, the privatisation of entire hospitals, ever increasing waiting lists for an appointment with a GP, births on parking lots; they could not care less! The rule has to be complied with because Brussels says so! When, on the point of breach of the law concerning medical laboratories and French medical offices Mr Brunet affirms: ", it is not a recommendation but a procedure linked to the violation of free circulation of capital". He simply brings attention to the rules imposed by the Maastricht Treaty on the principle of free competition established by article 87 of the Maastricht Treaty. So, in the name of this article, laboratories and health offices should become totally controlled by financial groups whose single motivation is profit making. And when Mr Brunet explains to the delegation that the goal of the commission is the ensure that new Member States can reach a better level of healthcare, he conceals the awful reality depicted by a Romanian trade union activist to the March 31st meeting. Indeed, she explained that the Romanian government decided to close down beds for the reason that there are too many hospital beds in Romania: an average 7.2 for 100 people while in the EU, the average is only 4.2 for 100 people! What conclusions can be drawn? Is the defence of public services, and their regeneration, compatible with the continuation of current EU institutions and compliance with the directives? Or, alternatively, does not this create a veritable challenge to these institutions? On the basis of the facts established by the delegation, we submit these questions as well as the entire report to all those, GPs, hospital staff, trade union members and activists who hold dear these gains because it is a question of civilisation. Initial appeal in preparation of the delegation to the Brussels Commission We are raising a cry of alarm:
The revolt against the closing hospitals, child care centers, and emergency services, in all countries, is spreading throughout Europe. - In Germany, for the last six months of 2006, all the sectors of healthcare workers, from doctors to nurses, have not ceased to strike and demonstrate in defense of their demands, which are directly linked to the defense of public health care, which is threatened with destruction by the budget cuts of 1.25 billion Euros in 2006 and the decision to close 25% of establishments. The hospital workers were backed up recently by 220,000 workers who demonstrated on October 21, responding to the call of their trade union confederation, the DGB, against the "reform" of health care discussed in the Bundestag. This is a "reform" aiming to destroy health insurance for 70 million people. This is a reform that would abolish the parity nature of the funds and imposes a complimentary contribution for the wage earners, with the explicit goal of pushing for competition between funds, with the goal of substitution individual insurance for collective solidarity coverage. - In Great Britain, in one town, 130,000 citizens signed a petition against the closing of their hospital, in a situation where the national health care system (NHS), set up after WWII, has literally been dismantled and privatized. - In France, a country where health care after the war was one of the best in Europe, not a month goes by without a demonstration of the people, with their elected representatives, against the closing of an emergency service, a neighborhood child care center, or a surgery center. This all takes place in a situation where patients are constrained, by the suppression of their rights to be reimbursed 100% of their expenses. - In Spain, a demonstration of the whole population, elected officials, trade unions, and doctors took place against the privatization of a hospital in the city of Leganes. - In Portugal, uprisings supported by MPs in the National Assembly have taken place against the imposition of "hospital rates" and against the reduction of medical reimbursements. - In Italy, two general strikes have taken place in the last two years, with the participation of 95% of doctors, against the destruction and the sell-of of hospitals due to regionalization. - In Denmark, tens of thousands of demonstrators protested against the consequences of budget restrictions in the child care centers and the hospitals, provoked by the regroupment of communes. - In Sweden, the mass mobilizations against "reorganizations" and privatizations of hospitals made the government, in 2005, retreat concerning the privatization of university hospitals. These measures are being implemented in the name of what? They all are arising because of the new budget principles dictated on our governments and our administrations by the European Stability Pact. We address you heads of the European Union. We ask you the question: Is it en exaggeration to denounce as a swindle the financial difficulties confronting the Social Security funds, at a moment where the exonerations of the social contributions of the bosses have become the rule throughout Europe, reaching 170 billion Euros in France in 15 years. Is it an exaggeration to make this accusation when the exonerations have reached nine billion Euros every year in Italy, when the Bundestag in Germany has put new corporate exonerations on the agenda in the framework of the "healthcare reform" proposed to be adopted in January? Is this all an accident or is it the implementation of Integrated Directive No. 15 of the European Union, which calls on member states to "reinforce measures of economic incentives, including through … a reduction in the non-wage labor costs"? Is a deficit in the social security funds the consequence of "an aging population" as they constantly tell us? Or is it the result of a systematic policy aiming to lower labor costs? Answer us. The combination of the Maastricht criteria with the Europe of regions is leading to the privatization of hospitals everywhere Are we mistaken in affirming that the accelerated policy of reducing
health care budgets and privatizing hospitals is directly linked to
the implementation of the policy of regionalization promoted by Brussels?
Isn't this the translation of Article 104 of the Maastricht Treaty, which stipulates that "the member states must avoid public deficits… . We understand by public, everything related to the general government, that is, the central administrations, the regional authorities, and the social security funds"? Isn't this the explanation for the acceleration of the sell-off of hospitals by the regions, the multiplication of "public-private partnerships," as well as the reduction in sickness reimbursements for all social security systems in Europe? Even in a country like Portugal, where the people have rejected regionalization, the government has proceeded to implement a reform of the administration, leading to the same results. What does it mean to push back the retirement age and simultaneously
reduce the expenses allocated for health care? We ask you the question: Is the solution you've found the Integrated Directive No. 2 from July 12, 2005, which stipulates that: "The member states should take into account the costs of the aging of the population by 1) reducing the public debt on a sufficient rhythm and 2) reforming their social security systems and health care to make them financially viable"? Allow us to sum up: The solution you have chosen - to push back the retirement age to 65 to 70 years, while reducing the expenses allocated for health - means that, for the European Union, the Integrated Directives, and the Maastricht treaty, the maximum amount of workers should die before reaching the retirement age. This is a serious accusation, but we present it based on the facts we present to you. We dare you to prove the contrary! The European Commission calls for "making professionals and patients responsible," but with what goal in mind? All the countries of Europe are confronted with the same problem. In Italy, in Great Britain, in Spain, and now in France and Germany, the waiting lists for consulting a specialist or a surgeon are going from 6 to 10 months. Those who have money go to private enterprises, but what about the others? The pressure to limit prescribing medications is growing in each one of our countries, creating an impossible situation for doctors and putting the lives of thousands into danger. Is this inevitable or is this the scrupulous implementation of the communiqué of the European Commission in December 2005, which orders that member states "adapt health care … through making healthcare professionals and patients responsible"? We are all confronted with dramas that are anything but inevitable.
These are dramas that, up until recently, were avoided in our countries,
including in Eastern Europe, which today are subjected to the directives
of the European Union. First endorsers: - Austria: Schmid Rudi, Austrian Social Democratic Party (SPÖ)/Initiative for a socialist policy of SPÖ (isp); Rietenauer Karin, PÖ/isp; Reimar Holzinger, SPÖ/isp; Peter Ulrich Lehner, Mitbestimmung; Alois Reisenbichler, SPÖ/ACUS; Stefan Woltran, SPÖ/PKJ; Alfred Heinrich, SPÖ/isp; Maier Theo, SPÖ/isp; Helga Theo, SPÖ/isp; Roman Roscher, SPÖ/isp; Werner J. Grüner, SPÖ/isp; Jürgen Hirsch, SPÖ/isp; Florian Wenninger. - Belgium: Philippe Larsimont, co-ordinator of the Movement of workers' defense; Rudy Janssens, federal secretary CGSP-ALR, Brussels region; Serge Monsieur, shop steward CGSP-ALR Vivaqua; Laurent Ringoet, shop steward CGSP-ALR, IRIS network (Brussels hospitals); Antoine Ruggieri, president of the FGTB pensioned and pre-pensioned metalworkers of Liège; Henri-Jean Ruttiens, full-time official of the office workers union FGTB; Jacques Aghion, pensioned teacher; Vincent Bianchi, CGSP affiliate; Jean-Maurice Dehousse, former mayor of Liège; Maximilien Lahaye, shop steward SETCa; Olivier Palmans, convenor CGSP Télécom-Aviation; Eric Polis, shop steward CGSP; Maxime Stroobant, emeritus professor VUB (Free University of Belgium); Jocelyne Urbain, shop steward CGSP, CHU Brugmann; Christel Deleforterie, shop steward CGSP, CHU Brugmann; Victor Ntacorigira, trade unionist, CHU Brugmann; Ioana Marin, CGSP, CHU Brugmann; Cédric Briand, shop steward CGSP, CHU Brugmann; François Herreman, shop steward CGSP, CHU Brugmann; Luc Lippens, shop steward CGSP, CHU Brugmann; Jan Cox, shop steward CGSP, CHU Brugmann; Marcel Temperville, shop steward CGSP, CHU Brugmann; Vincent Rizza, CGSP trade unionist, CHU Brugmann; Michèle Dehaen, shop steward CGSP, CHU Brugmann; Manuel Salas, CGSP, CHU Brugmann; Jean-Pierre Van Mol, doctor of medicine ; Pierre Seux, physiotherapy student; Pierre Bellière, First XR technician, CHU Liège. - Denmark: Erik Kaustrup; Kirsten Sørensen, People's Movement against the European Union (PMAEU), Rødovre; Ole Sørensen, PMAEU, Herslev; Vibeke Pedersen; Willi Ander, construction workers union; Jytte Ander ; Michael Johnsen, construction workers union; Eva Hallum, PMAEU ; Jørgen Bentzen, PMAEU, Herlev; Per Sørensen, PMAEU, Rødovre; Jesper Wehe, construction workers union ; Claus Westergreen, construction workers union; Aase Barfod, career councillor; Allan Søborg, construction workers union; B. Andreasen, construction workers union; Michael de Gier, construction workers union; Kim Bilfelt, construction workers union; Yvonne Madsen, construction workers union; Gitte Klang, construction workers union; Ebbe Dalgaard, construction workers union; Allan Martinssen, construction workers union; Ole Soborg, construction workers union; Svend Olsen, construction workers union; Ib Slot, construction workers union; Ib Ernst, construction workers union. - France: Professor A. Bizien, head of department at G.-Clemenceau hospital; Dr S. Belucci, doctor, university hospital lecturer; J. Bertault, nurse, trade unionist; Dr B. Bénet, hospital staff; Luc Beranger, Social Security trade unionist; N. Bernard, Social Security executive; Dr T. Bui, doctor in the private secto ; Dr J.-L. Chaberneau, departmental manager of paediatric emergency services at Béclère hospital; D. Chalier, nursing auxiliary, trade unionist; M. Chambonnet, nurse, teacher at IFSI; C. Cochain, nursing auxiliary, trade unionist; Noel Coudert, Social Security trade unionist; Dr M. Debat, doctor ; Dr P. Debat, doctor; L. Delrue, hospital staff trade unionist; Dr N. Delépine, doctor in a hospital; Dr M.-H. Doguet, psychiatrist; D. Dutheil, laboratory assistant, trade unionist; M. S. Dziomba, psychoanalyst; Professor F. Guérin; Micheline Guillemette, Social Security executive; J. Guillez, laboratory assistant; J. Guilliot, hospital executive; Y. Ho A Chung, nurse ; Dr M. Lagier, hospital doctor, trade unionist; Dr J.-P. Laporte, hospital doctor; O. Leibovitch, nursing auxiliary; Dr M.-P. Lemonnier, hospital doctor; P. Navarro, nurse, trade unionist ; Dr F. Paraire, hospital doctor; P. Audureau, president of a disabled people's association; B. Ricque, nurse, trade unionist ; Dr P. Rivière, psychiatrist, head of a day hospital; Denis Royer, Social Security trade unionist; Professor J.-C. Roujeau, doctor, hospital H.- Mondor; J. Saget, laboratory assistant, trade unionist; R. Sale, computor scientist, hospital staff, trade unionist; Dr P. Salvaing, doctor in a school; G. Saux, executive, hospital staff; Dr G. Tominez, doctor in the private sector; L. Viano, executive, hospital staff; F. Widtmer, hospital staff trade unionist; Christian Gicquelet, hospital staff trade unionist; Docteur W. Kedra, university-hospital doctor; Frédéric Pantier, hospital staff trade unionist; Robert Quintin, laboratory assistant; Corinne Thébaud, nurse; Georges Garnier, trade unionist; Daniel Crusberg, trade unionist, insurance sector; Patrick Leclaire, trade unionist, activist in a disabled people's association; Danielle Leclaire, trade unionist, activist in a disabled workers association; Patrick Chadelat, trade unionist insurance sector; Christophe Nogré, trade unionist, insurance sector; Philippe Chaure, hospital staff trade unionist; Pascal Ancarini, hospital staff trade unionist; Cédric Chambrodet, hospital staff trade unionist; Anne-Marie Gardant, nurse; Giuseppe Malacrino, hospital staff trade unionist; Docteur Juliane Lumbroso; Pierre Iwanoff, laboratory technician, trade unionist; Jean-Emmanuel Cabo, nursing auxiliary, trade unionist; Alain Beucher, Social Security trade unionist; Evelyne Jorry, nurse hospital Bichat; Alain Tiphaneau, nurse hospital Bichat; Gisèle Adoue, hospital staff trade unionist; Stéphane Gavelle, trade unionist; Anne Bourgeois, hospital instructor, trade unionist; Patrick Csukay, trade unionist; Rachèle Barrion, hospital staff, trade unionist; Christian Noguera, hospital physiotherapist, trade unionist; Jean-Jacques Peaud, nurse, trade unionist; Mariéva Geslin, nursing auxiliary; Brigitte Molines, nursing auxiliary, trade unionist; Brigitte Grégoire, social worker, Créteil CHI; Cécile Evano, nurse; Véronique Naulin, nurse; Régine Halope, retired nursing auxiliary; Dr Jacqueline Fraysse, Mpe Hauts-de-Seine ; Pierre Ellul ; Michèle Vincent, ophthalmologist physician; Caroline Pageard ; Claudine Denier ; Yannick Sybelin, head of an emergency service, member of the hospital board, trade unionist, Roanne hospital ; Muriel Sybelin, hospital staff trade unionist; hospital, Roanne hospital; Bruno Duray, computer technician, trade unionist, Roanne hospital; Béatrice Dutray, nurse anaesthetist, trade unionist, Roanne hospital ; Cristel Coste, hospital worker, trade unionist, Roanne hospital; Astrid Vial, medical secretary, member of the hospital board, trade unionist, Roanne hospital; Monique Berchoux, hospital staff, trade unionist, Roanne hospital; Véronique Orsatti, hospital staff, trade unionist, Roanne hospital; Gilles Massacrier, laboratory technician, trade unionist, Roanne hospital; Didier Marchand, cook, trade unionist, Roanne hospital; Catherine Garçon, nurse, trade unionist, Rennes; Rodolphe Verger, nurse, trade unionist, Rennes; Gérard Bertholet; Yannick Blondel, CGT HAD; Isabelle Le Cocq, CGT HAD; Yannick Perlaux, SUD Health HAD; Franck Dambo, CGT HAD; Docteur Marc Orpillard, hospital doctor; Docteur Nela Ramponi, paediatrician ; Samira Berouayel, nurse; Alain Breheret, trade unionist; Gérard Bariller, trade unionist; Doctor Marta Pepe, psychiatrist; Jacqueline Dupont; Danielle Frey-Deligne; Doctor Laurent Damon, General Practitioner; Fatiha El Abbassi; Renée Laurent, town councillor; Doctor Serge Drylewicz, psychiatrist; Maryline Laridan, nurse; Lucien Delyon, hospital worker, head nurse; Louisa Hilmi, hospital supervisor; Docteur Christiane Le Gouic, doctor - emergency services; Eric Andraud, hospital staff trade unionist; Chantal Gérard, hospital staff trade unionist; Nadine Reix, hospital staff trade unionist; Hugo Leiva Monreal, hospital staff trade unionist; Jean Michel Menager, hospital staff executive; Jean-Marie Nebbak, hospital staff trade unionist; Laurent Florance, hospital staff trade unionist; Aline Dotto, Voreppe, nurse in psychiatry, trade unionist; Monique Domergue, town councillor PCF, Talence ; Patrick Deswarte, hospital staff executive, hospital La Rochelle ; Dominique Martinez, hospital staff executive, hospital La Rochelle; Marc Bondonneau, nurse anaesthetist, hospital La Rochelle; Sophie Reymond, gynaecologist, La Rochelle; Bernard Camberlein, doctor in a hospital, Trinité (Martinique); Frédérique Mugnier, hospital staff executive, member of the hospital board, Dijon CHU; François Chartier, physiotherapist, Boscamnant hospital; Claire Chartier Frimaud, retired hospital staff, hospital Cadillac; Sylvie Caubet, nursing auxiliary; Marie Claude Martin, nursing auxiliary; Lydie Fizet, hospital staff trade unionist (Dieppe); Pascal Roger, hospital staff trade unionist (Dieppe) Annick Duhamel, nurse (Dieppe); Dr. Christiane Legouic, doctor in an emergency service (Dieppe); Régine Hermay, nursing auxiliary (Dieppe); Pascale Legry, nurse (Dieppe); Sylvie Pisaroni, nursing auxiliary, trade unionist (Dieppe); Pr. Pfitzenmeyer, head of geriatrist department, CHU Dijon; Hélène Barthe Roy, hospital physiotherapist; Ester Barnoeil, trade unionist; Jean-Raymond Bougras, trade unionist; Jean Grondin, hospital staff ; Mariette Dicanot, trade unionist; Jean-François Florenty, pensioner.
- Hungary: Laszlo Asztalos, metalworkers trade union official; Mrs Jatnos Beer, trade union official, Tatabanya hospital; Jozsef Perényi, president of the health workers trade union federation, representative of the Mecsek " workers' councils ". - Italy: Lorenzo Varaldo, co-ordinator in Italy of the International Liaison Committee of Peoples and Workers; Aurora Fulvio, doctor, vice-president "Democratic Medicine", national leader of the health sector of Communist Refondation; Rossana Beccarelli, hospital staff executive, Mauriziano hospital of Turin; Marzia Ghiberti, speech therapist; Paola Glisoni, speech therapist; Guido Montanari, university lecturer, Polytechnic Institute of Turin; Daniela Nespoli, hospital doctor, hospital Molinette; Dorino Piras, urology surgeon, head of andrology department, ASL 8 Piemonte; Vittorio Agnoletto, doctor, European MP; Sabrine Ambrosi, hospital nurse, hospital Molinette ; Anna De Leo, doctor, emergency service; Enrico Ruffini, pneumology surgeon, hospital Molinette ; Alessandra Algostino, professor of compared European Constitutional Law, University of Turin; Sabrina Ambros, hospital nurse, hospital Molinette; Ugo Cerchiari, Cancer Institute of Turin; Davide Ascoli, researcher, University of Turin ; Marinella Rossetti, nurse, Turin; Cancer Institute of Milan; Juri Bossuto, Piedmont Regional Councillor, Communist Refondation; Giorgio Faraggiana, University Rector; Gemma Gatta, head of department, analytic epidemiology; Andrea Micheli, head of department, epidemiology; Enrico Ruffini, pneumology surgeon, hospital Molinette, Turin. - Portugal: Ana Paula Ramos Fonseca, doctor, Centro de Saúde de Carnaxide; Manuel S. Soares, doctor, Centro de Saúde de Linda-a-Velha ; Henrique Coelho, health service technician, Centro de Saúde de Carnaxide; Maria da Conceição Santos, nurse, Santa Maria Hospital; Ana Rylde D. Monteiro, nurse, Instituto Português de Oncologia; Maria da Conceição Reis, doctor, ARS, Lisboa e Vale do Tejo; João de Deus Baptista Galvão, doctor cardiology specialist, Hospital de S. Francisco Xavier; John Peter Forei, doctor, neurology specialist, Instituto Português de Oncologia; Alvaro Neto Orfao, nurse, former mayor of Marinha Grande ; Antonio Frazao, doctor, Queluz health centre; Maria José Pires Gomes, nurse, Pinhal Novo health centre; Anibal Palma Mestre Machado, nurse, Garcia de Horta hospital ; Clarisse Bento, doctor, Marinha Grande health centre. - Roumania: Violeta Tudor, trade unionist SANITAS; Aura-Milena Tudor, physiotherapist student ; Ecaterina Doina Viscol, pensioner; S. Ovidiu Viscol, patient; Daniel Grigorie, trade unionist ; Florea Draghia, pensioner; Silviu Somicu, former MP; Constantin Ozon-Iancu, student; Valentin Busoi, pensioner; Dan Rotariu, former town councillor; Ilie Rotaru, former town councillor; Marian Tudor, former town councillor; Carmen Deciu, trade unionist SANITAS; Daniela Antonie, trade unionist SANITAS; Iulia Neatu, trade unionist SANITAS; Carmen Costache, hospital worker; Liana Tiberneac, trade unionist SANITAS ; Gianina Iovan, physiotherapist student; Adina Pandele, savings bank staff trade unionist, member of the national committee of the Socialist Alliance Party (PAS); Gheorghita Zbaganu, university teacher; Georgica Valcoreanu, doctor; Marcel Radut-Seliste, president of the Youth association CELEST; Paul Gabriel Vasile, vice-president of AEM. - Slovakia: Ilona Molnar, head teacher, vocational school. - Spain: Blas Ortega, president of the Medical Association in defence of patients and doctors rights (MADPDR), UGT, Valencia ; Luis González, trade unionist health sector, CC OO, Seville ; Isabel Serrano, president of the trade union shop stewards of Hospital Severo Ochoa, Leganés, Madrid ; J. Montes, doctor, hospital Severo Ochoa, Leganés, Madrid ; Luis De La Torre, UGT Health sector, Barcelona ; Teresa Ribelles, secretary of MADPDR, Valence ; Rafael Palmer, vice-president of MADPDR, Palma de Majorque ; Tomás Aparicio, trade unionist FSP-UGT, General University Hospital of Valence; Manuel Capilla, president of the community association Tres Forques of Valence ; Gloria Ferris, doctor, health administration, Valence ; Palmira Muñoz, nurse, FSP-UGT trade unionist, Valence; Carmen San José, General Practitioner, Madrid; Juan Pedrero Pérez, Executive Commission of the CC OO health federation, Andalusia ; José Luis Limia Valle, doctor, Seville; José M. Poyatos, general secretary of the CC OO health workers union, Cordoba ; Alejandro Oruna, president of the AAVV federation of Sabadell ; Antonio Amaro Granado, Executive Commission of the CC OO health national federation; Beatriz Herrero, shop steward CCOO, hospital Severo Ochoa; Carmen Ortiz, president of the federation of associations in defence of health public services; Catalina Santana Vega, doctor, Tenerife; Domingo Toledo, UGT member of the Health Institute of Catalonia; Esperanza Quesada, staff member at the Health Institute of Catalonia in Barcelona ; Fernando Pérez, doctor, shop steward CCOO, hospital Severo Ochoa; Fransisca Morales, shop stewards UGT, hospital Severo Ochoa; Jesus Rodriguez, shop steward CCOO, hospital Severo Ochoa; Joaquin Insausti, anaesthetist, hospital Severo Ochoa; Jose Luis Martinez, Executive Commission of the CC OO health federation of Catalonia; José Maria Hernandez Saenz de Tejada, shop steward LOLS, CCOO; Jose Miguel Garcia Cruz, shop steward CCOO, hospital Severo Ochoa; José Pedro Aranda, dentist, Madrid ; José Revert, MADPDR steering committee; Juan M. Gonzalez Rodriguez, doctor, Grand Canaries; Julian Ordonez, shop steward UGT, hospital Severo Ochoa; Julio Fernandez Garrido, professor at the nurses training school, University of Valence; Luis Pina Cuadraro, homeopathy specialist, Getafe, Madrid; M. José Carrasco, shop steward CCOO, hospital Severo Ochoa; Maria Soledad Fernadez Diaz, civil servant at the ministry of health; Miguel Angel Torrijos, shop steward, supervisor, hospital Severo Ochoa ; Miguel Uso, secretary of the health sector FSP UGT, Valence; Pablo Caballero, shop steward, hospital Severo Ochoa ; Pilar SanJurjo Gonzales, nursing auxiliary, Madrid; Ramona Fernandez, Social Security paediatrician, Madrid; Teresa Juanico Piris, Executive Commission of the CC OO health federation; Teresa Ribelles, secretary of MADPDR, Valence; Vincent Alcover, trade unionist, office worker, Valence University Hospital. - Sweden: Jan-Erik Gustafssonn, trade unionist in the public services. - Switzerland: Antonio Herranz, trade unionist SSP health branch, Montreux; Mathieu Contet, trade unionist SSP health branch, Fribourg; Joëlle Gyselinck, trade unionist SSP, health branch, Nyon ; Madeleine Montana, trade unionist SSP health branch, Vevey; Graziano Pestoni, MP PS, Ticino; Vilma Varela, trade unionist SSP, health branch; Véronique Landry, trade unionist SSP, member of the SP Lausanne; Delphine Bordier, trade union official SSP (Geneva), in her individual capacity; François Grenier, trade union official SSP (Health and social branch), in his individual capacity; Brigitte Sordoillet, trade unionist SSP, health and social branch, Ste-Croix; Gabriele Ghislaine, trade unionist SSP, health and social branch, Ste-Croix; Cochand Eric, physiotherapist, Peseaux; Cochand Danièle, day-care, Peseaux; Kunz Solange, nurse, Morges; Fontannaz Philippe, social worker, SSP, Bussigny; Kreis Tekla, nurse, Neuchâtel; Yasmina Produit, secretary of the SSP health branch, Neuchâtel. - Turkey : Dr. Zeki Kiliçaslan, professor of pneumology, Istanbul Faculty of Medicine, President of the Association for the eradication of tuberculosis , President of the Workers Fraternity Party; Yalçin Mutlu, President of the Social Security trade union, Eskisehir ; Ali Özek, President of the Bak?rköy Social Security trade union, Istanbul ; Gülgün Gün, specialist doctor at the medical research hospital of Göztepe (MRHG), Istanbul ; Mehmet Sar?msak, doctor at MRHG; Tuba Zengin Elbir, doctor at MRHG ; M. Fatih Kocakoztas, doctor at MRHG ; Seniha M. Konuk, doctor at MRHG; M. Salih Sahin, doctor at MRHG ; Mehmet Ali Isik, radiology technician at MRHG ; Muharrem K?z?lay, radiology technician at MRHG ; Havana Çobanoglu, radiology technician at MRHG ; Sevinç Duyuldu, technician at MRHG ; Halil Takir, technician at MRHG ; Zühre Kaya, technician at MRHG ; Sengül Ayd?n, technician at MRHG ; Cafer Sinirtas, radiology technician at MRHG ; Derya Sahin, technician at MRHG; Lütfiye Hizarci, nurse at MRHG ; Sevgi Ince, nurse and social security trade union representative at MRHG; Neriman Mogolkanli, nurse at MRHG ; Nadire Yildiz Ayar, nurse at MRHG ; Fatma Aydinli, nurse at MRHG ; Suzan Sat?c?, nurse at MRHG ; Gülden Bosgelmez, nurse at MRHG ; Aysun Baltaci, nurse at MRHG ; Vildan Özdemir hemodialyse nurse at MRHG ; Suat Suna, pharmacy departmental manager at MRHG ; Hüseyin Yayla, worker at l'MRHG ; Hüseyin Çevikkol, worker at l'MRHG ; Seher Çetin, worker at MRHG ; Nazife Ince, worker at l'MRHG ; Mustafa Turgut, worker at lMRHG ; Ünal Gelgeç, worker in the health sector ; Riza Tepe, worker in the health sector, ; Ismail Güler, worker de la sante ; Hasan Erol, worker in the health sector ; Arslan Çelik, worker in the health sector; Feti Derin, worker in the health sector ; Cemal Demir, worker in the health sector ; Burcu K?vrak, psychologist ; Gönül Uçar, worker in the health sector ; Necla Ince, worker in the health sector ; Aylin Sayan, dietician; Emine Çelebi, worker in the health sector ; Rukiye Kurtgöz, worker in the health sector ; Muammer Karabey, civil servant at MRHG ; Ramazan Sanli, civil servant at MRHG; Nur Koç, office worker at MRHG; Aynur Arslan, secretary of telecommunication at MRHG ; Oktay Perdeci, Istanbul Faculty of Medicine, Assistant-Doctor; S. Leyla Pur, Istanbul Faculty of Medicine, Assistant-Doctor ; Fatih Yakar, Istanbul Faculty of Medicine, Assistant-Doctor ; Emrullah Erdem, Istanbul Faculty of Medicine, Assistant-Doctor; Gülseren Sagcan, Istanbul Faculty of Medicine, Assistant-Doctor; Lale Öcal, Istanbul Faculty of Medicine, Dr.Professor of ophthalmology ; Nilüfer Alpay, Istanbul Faculty of Medicine, Assistant-Doctor ; Özer Taranoglu, Istanbul Faculty of Medicine, Assistant-Doctor ; Ömer Celal Elçioglu, Istanbul Faculty of Medicine, Assistant-Doctor; Ayça Erda Kurt, Istanbul Faculty of Medicine, Assistant-Doctor ; Esra Ünal, Istanbul Faculty of Medicine, Assistant-Doctor ; Sibel Aydin, Istanbul Faculty of Medicine, Assistant-Doctor ; Fatih Tufan, Istanbul Faculty of Medicine, Assistant-Doctor ; Halit Özsüt, Istanbul Faculty of Medicine, Senior lecturer ; Mehmet Güngör, Istanbul Faculty of Medicine, Dr.Professor of pharmacology ; Lütfiye Eroglu, Istanbul Faculty of Medicine, Dr.Professor of pharmacology ; Yüksel Pekçala, Istanbul Faculty of Medicine, Dr. Professor of haematology ; A. Emre Çamci, Istanbul Faculty of Medicine, Dr. Professor of intense care; K. Mehmet Tugrul, Istanbul Faculty of Medicine, Dr. Professor of intense care; Sacide Erdem, Istanbul Faculty of Medicine, Senior lecturer of cardiology ; Hasan Kudat, Istanbul Faculty of Medicine, Senior lecturer of cardiology ; Veli Uysal, Istanbul Faculty of Medicine, Dr. Professor of pathology ; Yener Aytekin, Istanbul Faculty of Medicine, Dr. Professor of histology ; Isin Kiliçaslan, Istanbul Faculty of Medicine, Dr. Professor of pathology ; Türkan Tansel, Istanbul Faculty of Medicine, Senior lecturer ; Ekrem Yavuz, Istanbul Faculty of Medicine, Dr. Professor of pathology ; Ridvan Ilhan, Istanbul Faculty of Medicine, Dr. Professor of pathology ; Dilek Yilmazbeyhan, Istanbul Faculty of Medicine, Dr. Professor of pathology ; Gökhan Budak, Istanbul Faculty of Medicine, worker ; Nese Kaya, Istanbul Faculty of Medicine, civil servant ; Lütfü Telci, Istanbul Faculty of Medicine, Dr. Professor of anaesthesia ; M. Can Karatay, Istanbul Faculty of Medicine,Dr. Professor of oto-rhino-laryngology ; Mert Sentürk, Istanbul Faculty of Medicine, Senior lecturer of surgery; Kamil Pembeci, Istanbul Faculty of Medicine, Dr. Professor of intense care ; Göksen Kircan, Istanbul Faculty of Medicine, physiotherapy specialist ; Nuri Gümüs, Association for the eradication of tuberculosis, worker; Gülnigar Odaci, Association for the eradication of tuberculosis, nurse; Tuba Gülay, Acibadem-Istanbul private hospital, biologist ; Birsen Yesilkanat, Association for the eradication of tuberculosis, nurse; Osman Avci, Istanbul Faculty of Medicine, technician ; Zeynep Devrim, Acibadem-Istanbul private hospital of Acibadem-Istanbul, nurse ; Ferruh Ergüven, Association for the eradication of tuberculosis, Technician; Hatice Altinkaya, Association for the eradication of tuberculosis, Worker; Can Çimen, Association for the eradication of tuberculosis, Worker ; Nermin Kapçioglu, Health, nurse ; Neslihan Yilmaz, Health - private sector, worker; Esra Karabacak, Health-private sector, Worker ; Arzu Yilmaz, Health-private sector, Worker ; Türkan Faka, Health-private sector, nurse ; Tülin Meleme, ministry of Health, nurse ; Hakan Karaman, ministry of Health, Doctor ; Tolgahan Meleme, ministry of ministère de la Health, Worker ; Fatma Keles, "Health Home"- State sector, Worker ; Alper Kaya, State Hospital, Doctor ; Füsun Ergin, private Hospital, Worker; Gamze Yalin, private Hospital, nurse ; Aysun Kotil, private hospital, nurse ; Orhan Arseven, Istanbul Faculty of Medicine, Dr. Professor of pneumology ; Aysil Yanmaz, Istanbul Faculty of Medicine, civil servant ; Fulya Çelikkol, Istanbul Faculty of Medicine, civil servant ; Tülin Ça_atay, Istanbul Faculty of Medicine, doctor and pneumology lecturer; Ziya Gülberen, Istanbul Faculty of Medicine, Dr. Professor of pneumology ; Hacer, from the Istanbul Faculty of Medicine, head nurse; Ufuk Memi ; Yüksel Deniz, Istanbul Faculty of Medicine, nurse ; Algin Erarslan, Istanbul Faculty of Medicine, secretary ; Hülya Bacaksiz, Istanbul Faculty of Medicine, nurse ; Münevver M. Aydin, Istanbul Faculty of Medicine, assistant lecturer ; Turhan Ece, Istanbul Faculty of Medicine, Doctor and professor of pneumology, Fin page 48 - bas de la 3ème colonne Reyhan Yildiz, Istanbul Faculty of Medicine, Assistant-Doctor ; Fatma Çömçe, Istanbul Faculty of Medicine, Assistant-Doctor ; Aysun Akdeniz, Istanbul Faculty of Medicine, Assistant-Doctor ; Teslime Hoskan, Istanbul Faculty of Medicine, laboratory assistant ; Adile Kayar, Istanbul Faculty of Medicine, laboratory assistant; Zekiye Yildiz, Istanbul Faculty of Medicine, nurse; Bahar Eraslan, Istanbul Faculty of Medicine, nurse; Naciye Sungur, Istanbul Faculty of Medicine, nurse ; Rübeyda Aci, Istanbul Faculty of Medicine, nurse ; Abdullah Asil, Istanbul Faculty of Medicine, worker; Esen Kiyan, Istanbul Faculty of Medicine, senior lecturer; Gülfer Okumus, Istanbul Faculty of Medicine, specialist doctor ; Osman Elbek, Faculty of Medicine of Gaziantep, senior lecturer; Tip Fükültesi ; Tülay Elbek, private health services, Doctor ; Nur Çimen, State hospital of Bulancak, Specialist doctor ; Sükran Dogan, health service workers union, member of the steering committee; Süleyman Bal, health service workers union, Samsun President; Salman Kiliç, health service workers union, member of the steering committee; H. Vildan Oktay, Association for the eradication of tuberculosis, Doctor ; Cem Sahan, Samsun State hospital, cardiology specialist; Ahmet Ekinci, Doctor of the oil industry workers union, Doctor; Mesut Ozansü, former MP and former member of the Council of Europe; Ahmet Tuleroglu, Doctor ; Rezzan Tuncay, Istanbul Faculty of Medicine, neurology lecturer doctor; Bektas Kisa, Association for the eradication of tuberculosis, Doctor ; Ozgül Acar, nurse, physiotherapy rehabilitation hospital of Samsun; Mustafa Aydin, public health services, civil servant, Samsun Faculty of Medicine hospital; Arzu Senel, nurse, Izmir medical research hospital; Ozlem Tumer, head of department, Surreyyapasa-Istanbul pneumology hospital; Umit Sahin, Specialist doctor, Human rights association; Sükran Irengin, Specialist doctor, Human rights association; S. Alper Tecer, Specialist doctor, Human rights association; Burhan Cabuk, health service technician, Istanbul Faculty of Medicine; Fevzi Issever, public health civil servant, Istanbul Faculty of Medicine; Gül Onger, psychiatry lecturer, Istanbul Faculty of Medicine; Kadir Paspinar, public health services, Istanbul Faculty of Medicine; Ramazan Yüce, health service technician, Istanbul Faculty of Medicine; Seahattin Simsit, public health civil servant, Istanbul Faculty of Medicine; Sultan Caglayan, worker, Istanbul Faculty of Medicine; Turan Karabas, health service technician, Istanbul Faculty of Medicine; Yücel Bodur, health service technician, Istanbul Faculty of Medicine; Sener Cul, worker, Istanbul Faculty of Medicine; Yasemin Duran Han, nurse, HREG ; Ozge Uzuner, nurse, HREG ; Saniye Kara, nurse, HREG ; Murat Harata, health services, health service workers union of Izmir ; Hüseyin Gülseven, health services, president of the health service workers union of Izmir; Sabiha Gürel, nurse, HREG; Sener Duran, public health services, HREG; Tülay Törün, specialist doctor, Surreyyapasa-Istanbul pneumology hospital; Kemal Tahaoglu, specialist doctor, Surreyyapasa-Istanbul pneumology hospital; Arzu Soyhan, specialist doctor, Surreyyapasa-Istanbul pneumology hospital ; Aynur Yilmaz, specialist doctor, Surreyyapasa-Istanbul pneumology hospital; Ayse Oztin Güven, Assistant-Doctor, Surreyyapasa-Istanbul pneumology hospital ; Ayse Kefeli, nurse, Surreyyapasa-Istanbul pneumology hospital ; O. Yazicioglu, Doctor, Surreyyapasa-Istanbul pneumology hospital; Ozden Solmaz, nurse, Surreyyapasa-Istanbul pneumology hospital; Berat Bayraktar, nurse, Surreyyapasa-Istanbul pneumology hospital; Canan Tahaoglu, Doctor, Surreyyapasa-Istanbul pneumology hospital; Dilda Duran, Doctor, Surreyyapasa-Istanbul pneumology hospital; Edru Sedef, nurse, Surreyyapasa-Istanbul pneumology hospital; Edanur Dülek, Doctor, Surreyyapasa-Istanbul pneumology hospital; Elif Tilki, nurse, Surreyyapasa-Istanbul pneumology hospital; Cemal Sabanci, Doctor, Surreyyapasa-Istanbul pneumology hospital; Emine Aksoy, Doctor, Surreyyapasa-Istanbul pneumology hospital; Erhan Insel, civil servant santé, Surreyyapasa-Istanbul pneumology hospital Surreyyapasa-Istanbul pneumology hospital; Dida Marasli, Doctor, Surreyyapasa-Istanbul pneumology hospital; Eylem Acutuk, Doctor, Surreyyapasa-Istanbul pneumology hospital; Fatma Serin, nurse, Surreyyapasa-Istanbul pneumology hospital; Filiz Ates, Doctor, Surreyyapasa-Istanbul pneumology hospital; Firuze Ozkan, nurse, Surreyyapasa-Istanbul pneumology hospital; Güler Biyik, public health services, Surreyyapasa-Istanbul pneumology hospital; Gülseren Akel, Doctor, Surreyyapasa-Istanbul pneumology hospital; Günel Kasikci, nurse, Surreyyapasa-Istanbul pneumology hospital; Haluk Cumhur, Doctor, Surreyyapasa-Istanbul pneumology hospital; Hamit Kaçar, civil servant, public health services, Surreyyapasa-Istanbul pneumology hospital; Hatice Yigit, nurse, Surreyyapasa-Istanbul pneumology hospital; Hüseyin Aldal, public health services, Surreyyapasa-Istanbul pneumology hospital; Kamil Irin, public health services, Surreyyapasa-Istanbul pneumology hospital; Leylz Bicek, medical secretary, Surreyyapasa-Istanbul pneumology hospital; Mehmet Recber, Doctor, Surreyyapasa-Istanbul pneumology hospital; Nazan Ozbucak, Doctor, Surreyyapasa-Istanbul pneumology hospital; Nermin Tarkan, nurse, Surreyyapasa-Istanbul pneumology hospital; Nur Keren, Doctor, Surreyyapasa-Istanbul pneumology hospital ; Nursen Akgöl, technician, Surreyyapasa-Istanbul pneumology hospital; Nilüfer Hilkopokli, Doctor, Surreyyapasa-Istanbul pneumology hospital; Oya Yesil, health service technician, Surreyyapasa-Istanbul pneumology hospital; Pinar Kaymaz, nurse, Surreyyapasa-Istanbul pneumology hospital ; Rabia Aslanpençesi, nurse, Surreyyapasa-Istanbul pneumology hospital; Meral Ozdemir, nurse, Surreyyapasa-Istanbul pneumology hospital; Hülya Ozçigdem, civil servant, public health services, Surreyyapasa-Istanbul pneumology hospital; Sabiha Ozer, Doctor, Surreyyapasa-Istanbul pneumology hospital ; Selma Yildiz, nurse, Surreyyapasa-Istanbul pneumology hospital ; Sema Köklü, Doctor, Surreyyapasa-Istanbul pneumology hospital; Sema Saç, Doctor, Surreyyapasa-Istanbul pneumology hospital; Songül Unal, nurse, Surreyyapasa-Istanbul pneumology hospital; Sibel Boga, Doctor; Sinan Agca, Assistant-Doctor, Surreyyapasa-Istanbul pneumology hospital; Sevilay Celikkan, nurse, Surreyyapasa-Istanbul pneumology hospital; Ipek Erdem, Doctor, Surreyyapasa-Istanbul pneumology hospital ; Gülten Yurteri, Doctor, Surreyyapasa-Istanbul pneumology hospital; Fatih Artvinli, civil servant, public health services, State hospital of Beykoz-Istanbul; Leyla Polat, State hospital of Beykoz-Istanbul; Filiz Aydin, public health services, civil servant; Nese Yenigül, public health services, civil servant; Yavuz Yasar, senior lecturer, Istanbul Faculty of Medicine. - Ukraine: Liudmila Chekelenko, trade unionist, teacher.
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Open World Conference of Workers