Union Syndicale has been hitting a brick wall for two years. We would like to switch to a mechanism aligned with the remuneration method (the principle of annual updating) by modifying the legal basis so that these ceilings can be adjusted each year and regularly take into account the level of the inflation rate and therefore, in fine, the real cost of health care in the various places of employment.
As far as the potential of our resources is concerned, we have some room for manoeuvre within the Staff Regulations, i.e. we could contribute up to 2% of our salary (as opposed to 1.7% at present) to improve reimbursement levels and types of benefits. We are not going to increase our contributions because the reserves accumulated over the years (contributions in excess of reimbursements) are sufficient and are estimated at 300 million euros. 300 million. We could, in fact, use this reserve to rebalance reimbursement rates over time for our colleagues. We are trying to forecast expenditure and develop certain policies. With the help of DG ECFIN, we have a follow-up on the management of the assets (the reserve fund accumulated over time). The biggest task is to be able to bring the legal bases (GIP) into line with the reality on the ground and adequate reimbursement of health care.
Coming back to the reimbursement rate, there are large differences between Member States. In Italy, for example, the rate for dental costs is very low. We think that the bases of calculation are no longer appropriate and we would like them to be brought into line with reality. So we have 27 Member States in the EU and more than 27 different health care systems, health insurances or mutualities. A big challenge is to get the JSIS system recognised in the Member States where our colleagues work. So there are many administrative problems for our members.
At the moment, one of the most important issues is health care in Italy. The mutual insurance system is open to all citizens residing in Italy (national insurance system) and our colleagues receive a card to access health care. The Italian government has unilaterally decided to withdraw this card from colleagues from the European institutions and has asked them to pay a large membership fee to access care. This is a political but also a legal problem which is currently being discussed at the level of the Commission, DG HR and with the Member State. The CGAM is obviously pushing to resolve this issue so that our colleagues in Italy do not find themselves in a difficult situation.
In the Netherlands, the health insurance system has been completely liberalised. Private insurers now manage the relationship between the health care providers and their members. As an international organisation, we were outside this system. We have several institutions present on the territory: the JRC-Petten, EMA, the European Patent Office, Eurojust, etc. as well as EU pensioners. A problem with overcharging by hospitals was therefore quickly detected: access to care was no longer guaranteed. The PMO was asked to contact the local players in order to find a solution. An agreement was reached with these insurers, a contract was negotiated: our colleagues are now affiliated to an insurance that allows them to benefit from agreed prices and not be overcharged. They can therefore benefit from a national insurance card which gives them access to care like any other Dutch citizen and are better reimbursed according to the rules of the Joint Sickness Insurance Scheme.
In Spain, a few years ago, we had several problems in terms of access to care (as in the Netherlands). Again, the PMO managed to get agreements at regional level to insure the colleagues on site.
We are currently discussing medically assisted reproduction (MAR), for which the 2007 legal basis did not provide for reimbursement if there were no pathologies in the parents. A number of colleagues were therefore not covered by the CGAM (e.g. LGBTIQ+ couples). The CGAM would like to find a solution in order to include everyone and to guarantee the reimbursement of MAR to everyone, thus putting an end to discrimination. In addition, still concerning MAR, some reimbursement rules would need to be reviewed in the light of scientific progress.
The major challenge within the CGAM is of course to maintain quality support through the social pillar that the JSIS constitutes and to ensure its reliability. It should also be mentioned that, despite having a bad press, the PMO is doing a tremendous job. They work on many more than 27 different health systems, which can be very complicated in some cases.