The European Union’s governance of health care and the welfare modernization agenda

Abstract

In the face of “permanent welfare austerity,” the European Union (EU) is increasingly involved in the governance of health care through various “new governance” tools. This development coincides with a growing interest in modernization of welfare, including health care. One of the fundamental critiques of new governance in the EU context concerns the (perceived) inability of new governance to protect the “social” against the “market” in Europe’s constitutional settlement. Using multi‐level governance and constructivist approaches, this article considers whether the EU’s governance of health care via the “Open Method of Coordination” advances a neo‐liberal agenda of health care modernization.

The regulatory state and the UK Labour Government's re‐regulation of provision in the English National Health Service

“…Today, all European Union (EU) member states have some form of national public health system that ensures near universal access to comprehensive services (Hervey 2008, p. 104). While their organizational elements differ markedly, all systems face similar and significant challenges.…”

“…2009). Within their individual health systems, member states experience these problems in different ways (Hervey 2008, p. 104). When the UK Labour Government took office in 1997, there was a perception that the NHS was facing a crisis: that buildings and facilities were old, equipment was inadequate, there were relatively few health professionals working within the system, and there was an under‐supply of appropriate care and long waiting lists for routine procedures (Stevens 2004, p. 37).…”

“…However, facing increased budgetary pressures together with the political imperatives of maintaining existing commitments to health care, EU member states are seeking to modernize their systems of provision. Specifically, they are striving to meet the goals of ensuring financial sustainability and providing universal access to high quality care (Hervey 2008, pp. 105–106).…”

“…Across the EU, these efforts take various forms, but they are united by the common belief that increasing the efficiency of health services and improving the balance of responsibility for health care provision between the state, the market, and society can reconcile these apparently contradictory ends (Le Grand 2003; Giddens 2007). Attempting to account for the various programs by which member states were approaching these significant challenges, Hervey found no evidence of a neoliberal agenda for health care modernization, and furthermore, no evidence that EU member states had abandoned “Continental European” social policy paradigms in favor of “Anglo‐Saxon” neoliberal models (Offe 2003; Hervey 2008, p. 115). In order to understand the trajectory of European health care reform, she concluded that the health policy literature needed “alternative explanations” (Hervey 2008, p. 115).…”

Conflict and Conflict Management in the Cross-border Provision of Healthcare Services

“…In other words, will the member states put aside their objections, strongly expressed in the course of negotiations over the Services Directive, to the encroachment of Community regulation on this area of social welfare? The EU has already entered the area of healthcare regulation through several routes, including free movement of health professionals and patients, the purchase of pharmaceuticals in other member states, coordination of social security and more recently the open method of coordination (Greer 2006;Hervey 2008;Hervey and McHale 2004;Kostera 2008;Lamping 2005;Martinsen and Vrangbaek 2008;Mossialos et al 2002;Palm et al 2000;Permanand and Mossialos 2005). For the reasons outlined above, the cross-border provision of services through patient mobility has redistributive consequences that are politically salient, suggesting that regulation is more likely to be blocked.…”