The Europeanization of Health Care Governance: Implementing the Market Imperatives of Europe

Abstract

The paper examines the Europeanization process and the impact of the European Union (EU) on national healthcare policies, using the example of Denmark. The analysis reveals that although health policy formally falls within the competence of member states, the impact of the EU is becoming increasingly conspicuous and has contributed to a gradual restructuring of healthcare boundaries as well as of some of its organizing principles. Furthermore, the process and impact have a de-structuring effect on the more traditional governance tools used in relation to healthcare. The paper concludes that the EU has a signifi cant impact and that we may be witnessing the formation of a new institutional legacy that represents the initiation of a Europeanized healthcare model: a model emerging around a new set of stakeholders, principles and structures, which includes the market, principles of free movement, patient choice and patient rights institutionalized and safeguarded by the EU.THE EUROPEANIZATION OF HEALTH CARE GOVERNANCE 171

With Luxembourg in mind … the remaking of national policies in the face of ECJ jurisprudence

“…regarding corporate taxation (Genschel and Jachtenfuchs 2010) and healthcare policy (Martinsen and Vrangbaek 2008). What is more, these adjustments can only insufficiently be described in terms of compliance or non-compliance.…”

The asymmetry of European integration, or why the EU cannot be a 'social market economy'

“…In highly innovative-or even 'artistic' (Hilpold, 2008)-decisions, it has also approximated the status of mobile students to that of migrant workers, and, in the case enforcing access to Austrian universities, 21 it has even ruled that Austrian taxpayers should pay for the education of German medical students who fail to qualify under numerus-clausus requirements at home. At the same time, the (active and passive) freedom of service provision was used to allow the access of foreign providers to domestic health care systems, and to require that patients seeking ambulatory and stationary health care abroad should be reimbursed by their national systems (Martinsen and Vrangbaek, 2008;Martinsen, 2009). In the meantime, moreover, the combination of EU citizenship, freedom of movement and non-discrimination on grounds of nationality is used to minimize national residency requirements that would limit migrants' access to national welfare systems (Wollenschläger, 2007;Egger, 2008).…”

“…2 of its 'Protocol on Services of General Interest' , which stipulates that 'the provisions of the Treaties do not affect in any way the competence of Member States to provide, commission and organise non-economic services of general interest' (Damjanovic and De Witte, 2008). At the same time, the Court has extended the rights of beneficiaries of publicly or collectively financed health care to avail themselves of more attractive or more timely services offered abroad, at the expense of domestic taxpayers or insurance funds (Martinsen and Vrangbaek, 2008), and the Commission has proposed a 'directive on the application of patients' rights in cross-border health care' that would systematize and generalize the case law. Beyond that, the Court's extension of the rights of personal mobility, non-discrimination and EU citizenship has reduced or eliminated member states' control over EU migrants' access to nationally provided public and social services and transfers (Hatzopulos and Do, 2006;Wollenschläger, 2007).…”

“On the doctor's orders”: A pilot study of the effects of website marketing for medical specialist providers under gatekeeping arrangements

“…The family physician also traditionally chooses the medical specialist provider, usually without much involvement from patients themselves (Earwicker & Whynes, 1998;Victoor et al, 2013;Vrangbaek, Østergren, Birk, & Winblad, 2007). Since the late 1990s, health care reforms have been gradually introduced in the Netherlands and most other Western-European countries that aim to facilitate increased competition between health care providers (Helderman, Schut, van der Grinten, & van de Ven, 2005;Martinsen & Vrangbaek, 2008). Among others patients' rights to choose their own health care provider were installed, and private medical specialist providers were given entry to the market.…”