Health Telematics (AIM) Final Report
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AIM initiatives in the context of Community policies

1. Rationale

AIM's structure, mission and achievements can be understood only in connection with the overall evolution of six policies: industrial, competition, single market, R&TD, cohesion and regional policy and more recently, the Information Society policies. Competitiveness, Innovation and TEN policies are considered in the present text within the more general framework of the industrial policy (see chart 1).

Furthermore, the impact of AIM can't be judged properly if national policies aren't taken into consideration: namely the Health policies as a prerogative of the member states, and the national Telecommunication policies.

The general evolution in the Community law though the Single Act Treaty and the Treaty on the Union are also part of the scenario to be considered when evaluating AIM's structure, mission and achievements.

In this chapter we will outline the history of AIM according the first and second framework Programmes (1984-1987 and 1987-1991) and in parallel with the evolution of the main concerned Community policies and with the intervening modifications of the treaties. This reference to the past will be completed with an outline of the period 1991-1994, corresponding to the Third Framework Programme. In that period the Treaty on the Union entered in force and the Single market was in principle achieved, both with a strong impact on the management of AIM.

With this purpose in mind we examined the main institutional documents produced during the period 1984-1994 (see enclosed list). Few references to the years 1995-1996 will also be done in order to explain the prosecution of the considered policies, namely the Telecommunication policy, the Innovation policy and the TEN policy.

2. Community R&TD policy in the eighties

Great disorder reigned in Community research affairs at the beginning of the 1980s. In the preceding decade, despite the Council's resolutions of 1974, there was no Community policy on science and technology. Governments were on the whole opposed to any extension of Community activities in the area, and every single programme had to be unanimously approved by the Council either by reference to Article 235 of the EEC Treaty, or on the basis of the EURATOM and ECSC Treaties. In such a situation Commissioner Guido Brunner and Director-General Günter Schuster had to adopt a pragmatic approach, taking advantage of a crisis in some sector or other, or citing public interest in a particular field of research, in order to try to persuade the Council to accept new Community initiatives. In this way, the main body of research originating in EURATOM, with nuclear fusion in pride of place, was gradually joined by research programmes in energy, environment, health, textiles, fishing, raw materials, and many others. These programmes were often on a very reduced scale, and there were absolutely no links between them.

Between 1982 and 1983, commissioner Davignon, working with the new Director-General Paolo Fasella, with CODEST [1] and with CREST [2], began an attempt to reorganise the individual research and development activities and to include them in a more comprehensive plan which might serve as the basis for a real policy for science and technology. Drawing together all the separate research and development programmes in the field of technology in a Framework Programme designed to last over several years, the Commissioner intended to provide the Community with a means of selecting and orchestrating scientific and technological aims: a means of planning which could co-ordinate Community and national activities and a means of financial provision.

In July 1983 a Council decision put in force the 1st Framework Programme for R&TD (1984-1987, funded with 3750 MECUs). Nevertheless the attitudes of some member states remained negative toward Community involvement into R&TD.

In the 1st Framework Programme the new technologies were divided into 3 main areas: industrial technologies information and communication and biotechnology. Apparently good for expanding the Telematics market in all fields, including Health Care: but let's look carefully inside the issue.

-The basic inspiration in setting up programs like ESPRIT was to ensure that companies took responsible from Programme through cost-sharing, the fostering of co-operation between companies, and the expansion of collaboration between business, research centres and universities. This excluded users' deep involvement and excluded also a primary role of the Programme in the orientation of the Market, by stressing the criteria of pre-competitiveness and pre-normativity [3].

-In telecommunications, unlike information science, the main involvement with the Community was not with Business but with Public Authorities. The pilot phase of Race lasted July 85-Dec. 86 and was funded 40 MECU. The 1st phase of Race was in the 2nd Framework Programme 87-91 (550 MECU) and drew together business, university, research centres and Telecom operators. Areas of interest were strategies for broad band, IBCN technology and pre-normative functional integration, but like in Esprit, marketable product and deployment were not considered.

-In 1989 as part of the 2nd Framework Programme, 3 programmes (DRIVE/DELTA/AIM) were launched to respond to the often reiterated demand that Community R & D should not merely react to the real or imagined technological gap which existed between EUROPE and USA or JAPAN but should attempt to draw up its own new direction for research and new applications of general interest.

3. Community policy in telecommunication in the eighties

At the beginning of the Eighties Telecommunication was a sector in which Europe could compete on equal terms with both the United States and Japan, but in which international competition was very keen and technological progress particularly rapid, so that no-one could hope to enjoy the fruits of success for long. The situation became more complex and diversified with the decision of the American government to break the monopoly of AT&T on the American market. The dismembering of AT&T in 1982 led to an intensification of competition between the giants in the sector, and to a huge increase in the number of services and products on the market. The European situation was characterised on the one hand by the strong positions of the "national champions", some of which had close collaborative relationships with American firms, and on the other by the control of transmission networks by the national post and telecommunications administrations. As in many other sectors, the greatest European limitations came from the fragmented market, the lack of common laws and standards, and the consequent lack of continent-wide infrastructure capable of rapidly developing the services demanded by the market, such as the transmission of data and images, electronic mail, and the interconnection of data banks.

Community policy in telecommunications, outlined in 1984 and redefined in 1987, was mainly oriented to establish European standards for equipment and terminals, which would allow these products to develop a true common market. In this field, the creation in 1988 of the European Telecommunications Standards Institute (ETSI [4]), modelled on CENELEC (European committee for Electrotechnical Standardisation), was a notable success. A second objective was the co-ordination of the development of continental infrastructure : all the countries of Europe were to adopt the same standard (ISDN - Integrated Services Digital Network) when they converted their telephone networks to a digital system. For the development of telecommunications in the less economically advanced areas, the Community established the STAR programme (Special Telecommunication Action of Regional Development) in 1986; while for the electronic data transmission for commercial purposes a programme was launched in 1987 for the creation of a network of services with a high added value (TEDIS - Trade Electronic Data Interchange Systems). Besides this, the Community proposed to co-ordinate policies of the postal and telecommunications administrations of Member States in international negotiations. The final objective was to transfer responsibility for the entire telecommunications sector to the Community in 1995, while the sector should be entirely deregulated by 1998, national resistance and technical difficulties permitting.

4. The single market: a key policy for AIM

In the seventies, along with oil crisis, member States, which were forbidden to adopt quotas by the common market accords, resorted to non tariff barriers such as subsidies to companies in crisis, public acquisition reserved for national companies and special rules and regulations, all measures which were intended as de facto obstacles to goods produced abroad.

On January 14, 1985 Jacques Delors told the European Parliament that the Commission's main political duty was to eliminate all of Europe's internal borders by 1992 .

For dismantling the member states' protectionism the implementation of the Single Market, was needed. The Single Market legislation, by the way, is not a monolith achieved once for ever. The Telecommunications issue, in particular, started to find a solution only in the nineties.

The single market includes: freedom of movement of goods, services, capitals and people. Delors' White paper in 1985 set out two other objectives to be pursued in order to achieve real economic integration in Europe: namely the elimination of discriminatory practice in public acquisition and procurement, together with the elimination of the states subsidies.

Between 1985 and 1992 the completion of the Single market and the strengthening of the R&TD policy represented two processes that moved forward in parallel.

-In June 1987 the Commission presented a green paper on developing a common market in telecommunication services and equipment.

-In June 1990 the Council adopted a directive related to the provision of open Telecommunication network.

-In November 1990 the Commission adopted a Green paper on satellite Communications

5. The Single European Act and the R&TD policy

The Single European Act which was approved in February 1986 entered in force in July 1987. It introduced a series of policies, including policy for Research and Technology for which the new co-operation procedure was foreseen.

Mainly, it represented a formal commitment from each member state to complete the Single market, and in consideration of the access of 3 fragile southern economies (Greece in 1981, Spain and Portugal in 1986) introduced policies of economic and social Cohesion (via the structural funds, Feder, FSE and Feoga-or).

The Single Act added a Title VI to the EEC Treaty with a view to legally covering research and technological development activities: the Community undertook to implement research, development and demonstration programmes, thus promoting co-operation with industry, research centres and universities; to promote co-operation with third countries and international organisations; to disseminate and use the results of research; and to give impetus to the training and mobility of researchers. Article 130i presents the general outline of the organisation of Community research: "A multiannual framework programme, setting out all activities of the Community, shall be adopted by the Council (...). The framework programme shall: establish the scientific and technological objectives to be achieved (...) and fix the relevant priorities; indicate the broad lines of such activities; fix the maximum overall amount and the detailed rules for Community financial participation in the framework programme and the respective shares in each of the activities provided for".

The framework programme must be adopted unanimously by the Council of Ministers, subject to consultation of Parliament and the Economic and Social Committee, whereas its activation via specific programmes is adopted by a qualified majority of the Council in co-operation with Parliament. Provisions are made for possible complementary programmes in which only a few Member States will participate, co-operation with third countries and international organisations, and the creation of joint undertakings.

The objectives set out by the Single Act for Community research were primarily economic. The scientific and technological foundations of European industry must be bolstered in such a way that they boost its competitiveness internationally and promote geographically homogeneous development. In particular, the Single Act has established a close link between research and the completion of the Single Market: the Community encourages co-operation between companies (including small and medium)sized companies), research centres and universities, "aiming, notably, at enabling undertakings to exploit the internal market potential to the full, in particular through the opening up of a national public contracts, the definition of common standards and the removal of legal and fiscal obstacles to that co-operation" (Article 130f). Many Commission directives concerning the completion of the Single Market have a direct impact on science and technology. Genuine economic integration requires common standards and norms, a step which can be achieved through the reciprocal recognition of national standards, or through harmonisation. Both the development of new technologies and their rapid commercialisation require that the national organisations in charge of creating standards and industries work in a co-ordinated manner and set homogeneous standards at European level "up-stream" of the production process.

6. The Single European Act and the 2nd Framework Programme (1987-1991)

On 28 September 1987 the Council agreed on 5.4 billion for the second Framework Programme for R & TD, 10% not to be spent before 1992 the sixth year of the five year plan, accounting for less then 3% of the total Community budget and equivalent to 1.8% of what the Member States spent on Research.

The four criteria of choice which justify a Community research action, drawn up in 1983 the so called Riensenhüber criteria, were bolstered by a fifth.

-research conducted on so vast a scale that single Member States either could not provide the necessary financial means and personnel, or could only do so with difficulty;

-research which would obviously benefit financially from being carried out jointly, after taking account of the additional costs inherent in all actions involving international co-operation;

-research which, owing to the complementary nature of work carried out at national level in a given sector, would achieve significant results in the whole of the Community for problems to which solutions call for research conducted on a vast scale, particularly in a geographic sense;

-research which contributes to the cohesion of the common market, and which promotes the unification of European science and technology; as well as research which leads where necessary to the establishment of uniform laws and standards.

-research which contributes to the strengthening of the Community's economic and social cohesion, as well as to the promotion of its harmonious and widespread development, while maintaining its consistency with the objective of technical and scientific quality.

7. From the Single Act to Maastricht: 3rd Framework Programme (1991-1994)

The third framework program (1990-1994) was approved by the Council on 23 April 1990. The specific programmes were reduced to 15, within six actions, which were in turn collected under 3 titles: dissemination technologies, management of natural resources and exploitation of natural resources.

The first title covers two actions: information and communication technologies and industrial and material technologies. Total funding for information and communication technologies was ECU 2221 billion, slightly less then in the previous Framework Programme, but still the highest in absolute terms and equivalent to almost 40 of the Framework Programme budget.

More than half of the funding went to information technologies via the Esprit Programme.

In approving the third Framework Programme the Council indicated the six main concerns that have influenced the choice its main guidelines:

It is clear that these "concerns" have points in common with the "Riesenhüber criteria" that were drawn up with regard to the First Framework Programme, and are an explanation of the general objectives set out for research and development. The first three objectives are linked strictly to the project to complete the Single Market and to the more general objectives set out in the Single Act, while the other three have a somewhat novel nature, signalling the expansion of the aims of Community research and development policy, an expansion that would be legally sanctioned by the Treaty of Maastricht.

As had been pointed out by Parliament and the Commission, the budget planned for the five years of the Third Framework Programme was too low and the hopes that the Fourth Framework Programme would have already started in 1993-thus partly overlapping the last two years of the previous programme-were overly optimistic. In order to advance activities which in many cases had barely begun, the Commission proposed supplementary funding for 1993 and 1994 of ECU 1,600 million, to be concentrated in information technologies, Telematics systems, industrial and materials technologies, the environment, biotechnology, agricultural research, non-nuclear energy and fusion. On 15 March 1993 the Council definitively approved a supplement of ECU 900 million for the Third Framework Programme, corresponding to an increase of 30.6% of the budget for actions in the field of energy and an increase of 13.3% in all other areas.

The events surrounding the financing of the Third Framework Programme reveal the continuing underlying tension between the Commission and Parliament on the one hand and the Member States on the other, regarding the relative importance which the Community's commitment to science and technology must assume.

Two fundamental issue are linked to the financing of Community R & D. The first regards the areas of competence between the Community and the Member States and falls under the Principle of Subsidiarity, already present in the Single Act Treaty and returned in the Treaty on the Union. The second is the one generally referred as additionality: should Community funding be considered an addition to national R&D budgets or part of them?

8. The Treaty of the European Union and the nineties

The Maastricht Treaty brought several new areas of policy of overwhelming importance in order to evaluate AIM's impact. To settle questions regarding the respective competencies of the Community and the Member States the Treaty introduced the concept of subsidiarity.

The two lines added to Article 130f were potentially of high importance. Whereas the Single Act simply stated that "The Community shall have the objective of strengthening the scientific and technological bases of Community industry and encouraging it to become more competitive at the international level" the Maastricht Treaty adds "While promoting all the research activities deemed necessary by virtue of other chapter of this Treaty".

With this change to Article 130f, the Maastricht Treaty gave more obvious legitimacy to those research activities which, though already initiated under the auspices of the Community on the basis of Article 235 of the EEC Treaty, are not directly concerned with the competitiveness of European Industry. The social impact, which is one of the major challenges of the R & TD in Health Care Telematics, benefits from this change in legislation.

-Another major changes appeared in Article 130h where it the Maastricht Treaty laid down that: "The Community and the Member States shall co-ordinate their research and technological development activities so as to ensure that national policies and Community policy are mutually consistent" (Article 130h).

-With article 129b it became evident that, though the original basis of the Single Market was a framework of legislation and regulations, material measures were now required, with governments undertaking to build major trans-European networks in the transport, energy and telecommunications sector.

9. The information society

On December 1993 the Commission presented a White Paper on Growth, Competitiveness and Employment which was a milestone in fixing the political priorities for the Union. The document underline the difficulties in the implementation of the Trans-European network in spite of article 129b, which consider the Action of the community within the framework of a system of open and competitive markets.

It mentioned The Information Society as such already as a type of society where management, quality and transmission, speediness of information becomes a key factor for competitiveness. Some services having been till now an exclusivity of the Governments, with increasing budget cut, could be transferred to the Market. The essential role of technology transfer in the development of technological innovation is also highlighted in Delors' White Paper.

The European Council, meeting in Corfu in June 1994, discussed the perspectives opened up by the so called Delors' White Paper together with the Report titled "Europe and the global information society" better known as the Bangemann report on the information society.

Many concrete initiatives took place on the base of those documents, including the global Information Society projects which started in February 95, on the initiative of the G7 countries.

The directive creates a new "sui generis" right for creators of databases, valid for 15 years, to protect their investment of time, money and effort, irrespective of whether the databases is innovative.

The harmonisation requirements of Member States rules in this area fall under EU's ONP (open network provision) framework which is concerned with open and efficient access to, and use of, the public Telecom networks and services. Legislation in these areas is issued under article 100a and is expected to be coherent with legislation issued under article 90 (competition).

Ciampi's group worked on competitiveness and produced various interesting documents in the preparation of the IGC; on 14.9.94 the Commission presented a communication on "an industrial competitiveness policy for the European Union". The innovation policy was also examined in a Green book published from the Commission in December 95: the promotion of the Information Society was one of the action favouring the innovation.

The liberalisation of the Telecom, has to be completed by 1st January 1998: the corresponding directive was issued 29 Feb 1996 at the initiative of Commissioners Martin Bangemann and Karel Van Miert [5] issued under Treaty Article 90, the directive fixes the date for full liberalisation into European Union legislation and sets out deadlines for progress in national implementation in preparation for this goal.

Underpinning the directive is the recognition that competition in the presence of necessary regulatory safeguards, enhances the provision of universal service.

Member States must notify the Commission of measures to ensure universal service by 1st July 1997 at the latest. This directive open up the markets in voice telephony and public network infrastructure.

Restrictions have already been abolished in satellite, cable and mobile communications and on 1st July 1996 use of all alternative structures (such as the Telecom networks of railway, energy and water companies) have been liberalised for carriage of commercial Telecom services.

Alongside the lifting of government restrictions, the full competition directive also sets down broad competition principles as regards the appropriate national regulatory frameworks for the post 1998 environment. This concerns in particular interconnection, licensing, and financing of universal service.

Universal Service is was the subject of an adopted Parliament and Council Directive applying open access rules to voice telephony.

Consumer protection is also a key policy (article 129a).

Public Health is an action identified in article 129.

Footnotes:
  1. The Codest (Committee for European Development of Science and Technology) was created in 1982 . Like the Crest and the IRDAC committees, it was one of the major sources of inspiration for science and technology, moving on from the narrow objective of reduction the technology gap from the USA.
  2. CREST (Scientific and technical research committee) was created in 1974 to help the Council and the Commission and is formed by representatives of the member statas and the Commission.
  3. In 1982, FAST, a DG XII action Programme set up in 1978 for forecasting a technology assessment underlined the industrial relevance of the ESPRIT Programme but criticised the scant attention given to the socio-economic needs which technologies development ought to serve.
  4. ETSI is an indipendent, self funding organisation bringing together nearly 500 European and global organisations active in the telecommunications, broadcasting and IT industries. ETSI's task is to set common voluntary standards for Europe. By 1996 it celebrated the publication of its 1000th deliverable.
  5. The directive is based on the discussion process launched in 1995 by the Green Paper on mobile and personal communications.

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