European Union and Health Policy: The “Chaordic” Dynamics of Integration^*

Abstract

Objective. The objective of this article is to analyze the various components of EU health policy and to propose a conceptualization of the Europeanization of different countries' health policies. Method. Drawing on the methodology of public policy analysis, the authors identify core policies and their developments. They focus on the political processes and the stakeholders involved, and discuss future policy outcomes and their consequences. Results. The results show a two-sided picture: on the one hand, Europeanization in the health policy field primarily results from indirect impacts, rather than from direct treaty-based provisions or from a clear-cut sectoral policy; on the other hand, the EU exercises an increasingly strong influence over health policy in Member States, justified by internal market imperatives as well as public health requirements. Conclusion. The conclusion identifies a growing European health policy compound characterized by new, complex, and often overlapping responsibilities between the national and supranational levels. It conceptualizes the Europeanization of health policy as a differential, multiple, and often accidental process, the effects of which nevertheless tend to be quite systematic.This article aims at systematizing the multiple ways in which European integration impacts on the apparently exclusive national domain of health policy. The role of the European Union (EU) provides evidence for conflicting assessments. Though the picture may at first seem contradictory, this article tries to find a logical explanation behind the puzzling mosaic. It argues that the Europeanization of health policy is a phenomenon that tends to be ''chaordic,'' a term borrowed from Hock (2000) denoting a combination of chaos and order. Hock coined the term from a management point of view, as a cognitive point of reference for successful leadership in complex, self-organizing, and self-governing organizations, communities, or systems that are neither hierarchical nor anarchic. In the case examined here, the Europeanization of health policy, this particular combination of chaos and order results from at least three factors: the existence of both national and European authority over various aspects of the health policy field; the n Direct correspondence to Wolfram Lamping,

The weakness of strong policies and the strength of weak policies: Law, experimentalist governance, and supporting coalitions in European Union health care policy

“…The EU's constitutional asymmetry has heretofore allowed the ECJ to wield power over health care in Max Weber's classic definition of power as the “chance of a man or a number of men to realize their own will in a social action even against the resistance of others” (Weber 1946, p. 180). There is essentially no evidence of economic, political, or social supporting coalitions behind the ECJ's move into health care services (Martinsen 2005; Greer 2006; Lamping & Steffen 2009). As with most social policy, there was minimal demand for integration and member states were reticent about writing it into the treaties as an EU competency.…”

Dyrektywa o transgranicznej mobilności pacjentów – uwarunkowania ekonomiczno-polityczne oraz prawno-administracyjne

“…Wpływ Unii Europejskiej na politykę zdrowotną wykracza znacznie poza skromny mandat prawny zdefi niowany w traktatach. Jednak w literaturze przedmiotu dominuje przekonanie, że europeizacja polityki zdrowotnej pozostaje dość chaotycznym procesem (Lamping, Steff en, 2009, s. 1361-1379. Jej aktualny stan nie wydaje się być efektem zaplanowanej i świadomej polityki.…”

The rise of a European healthcare union

“…One line of research focuses on crises-or problem-driven dynamics where the outbreak of communicable diseases, such as AIDS or the BSE crisis, or shared public health problems, such as obesity, have pushed for European solutions. In this expansion of Union involvement, the European Commission is presented as a successful entrepreneur that seized the window of opportunity and expanded EU power and provisions (Lamping and Steffen 2009;Steffen 2012;Kurzer and Cooper 2011;Greer and Löblová 2016, this volume). Confirming the neo-functionalist focus on the stimulating role of non-state actors, the DG SANTE is presented here as a key institution that accepted political leadership and ensured EU involvement in public health.…”

“…EU involvement in healthcare policies initially developed along two different tracks. a. EU public health policies concerning issues such as AIDS, cancer, smoking, blood safety, BSE, SARS, Ebola, and ageing were partly based on the policy networks of health professionals (Lamping and Steffen, 2009;Trubek et al, 2009); b. The second track is the application of the principle of free movement in the EU's internal market to national healthcare systems in particular by the Court of Justice of the European Union (CJEU) at the request of the national courts (Brooks, 2012;Leibfried, 2010;Martinsen, 2005).…”