This volume assesses the impact of European Union (EU) policy and law on Member States' health systems and their governance in a number of key areas. In so doing, it builds on two earlier books 1 that sought to assess the changing legal and policy dynamics for health care in the wake of the European Court of Justice's (ECJ) seminal rulings in the Kohll and Decker cases. 2 These books showed that, despite widely held views to the contrary, national health care systems in the EU were not as shielded from the infl uence of EU law as originally thought. 3 The explicit stipulations of Article 152 EC (as amended by the Amsterdam Treaty) that health is an area of specifi c Member State competence, and implicit understanding of the subsidiarity principle where policy is undertaken at the lowest level appropriate to its effective implementation, proved not to be the 'guarantees' of no EU interference in national health care services that they were often held to be. As the raft of legal cases and degree of academic attention that followed have shown, Kohll and Decker were certainly not the 'one-offs' many policy-makers hoped they would be. 4 In fact,
In the context of macro-economic surveillance, the European Union(EU) increasingly addresses national health system reform. Member States receiving financial assistance are required to implement detailed reforms stipulated in 'Memorandums of Understanding' (MoUs). But the health systems in other (non-MoU) countries are also scrutinised in the context of the 'European Semester': through this annual policy cycle, the EU has continuously strengthened the tools it uses to enforce compliance. This article aims to open the black box of the EU's economic surveillance of national healthcare systems by outlining the complex policy architecture of the EU's newly acquired role in this area. The story of how health has emerged on the European agenda illustrates how the Eurozone crisis created a policy 'window of opportunity' to push through fiscal surveillance of health systems as part of the solution to the crisis. The cognitive frameworks put forward by certain elites added up to the primacy of an economic perspective over health objectives. Finally, our analysis of the role of the actors involved in the elaboration of EU guidance in the field of health points to the dominance of 'economic' actors and relative absence of 'health' actors, in spite of increased attempts by the latter to gain influence.
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