Time for a paradigm change? Incorporating transnational processes into the analysis of the emerging European health-care system

Abstract

Health services have long been insulated from the process of European integration. In this article, however, we show that we are witnessing their re-configuration in an emerging EU health-care system. The article uncovers the structuring lines of this system by focusing on three interrelated EU-wide processes influencing the integration of national health-care systems into a larger whole. First, the privatisation of health-care services following the constraints of Maastricht economic convergence and the EU accession criteria; second, health-care worker and patient mobility arising from the free movement of workers and services within the European Single Market; and third, new EU laws and country-specific prescriptions on economic governance that the EU has been issuing following the 2008 financial crisis. The article shows that these processes have helped to construct a European health-care system that is uneven in terms of the distribution of patient access to services and of health-care workers’ wages and working conditions, but very similar in terms of EU economic and financial governance pressures on health care across EU Member States.

National heroes, disposable workers. How collective action in the health and social care sector during the pandemic negotiated with the self‐sacrificing worker ideal

“…The Covid‐19 pandemic brought enormous pressures to the health and social care sector, exacerbating the contradictions of a capital accumulation regime which commodifies care services to profit from them while delegating the less lucrative aspects of care to families and communities (Fraser, 2017). In Italy, the pandemic found a public health and social care service weakened by years of cutbacks (Pedaci et al., 2020) pushed for by national as well as European economic governance (Stan & Erne, 2021), with H&SCWs facing more than ever the dramatic consequences of a model which relies on cost‐containment of their labor through understaffing (Pavolini & Vicarelli, 2012), job intensification, low pays, atypical contracts (Pedaci & Di Federico, 2014), and outsourcing (Mori, 2020). Indeed, while treated as disposable, now they also incurred higher risks of contracting a potentially lethal virus compared to other workers (Marinaccio et al., 2020).…”

Bringing society back into our understanding of European cross-border care

“…More importantly, the national character of healthcare systems themselves has been challenged by global and European processes of transnationalization and marketization (Stan and Erne, 2021). The building of the Single European Market through the freedom of movement of workers and services has led to many EU countries having recourse to non-national healthcare workers, many from other EU member states.…”

The wages of reconstruction – the EU’s new budget and the public service staff shortage crisis on the EU’s eastern periphery

“…Due to low public sector wages 3 and often humiliating working conditions, fewer and fewer people are to be found working in the essential public service professions of medicine, nursing and teaching. The situation has been aggravated by workforce emigration, driven by higher wages and better working conditions in ‘old’ Member States and the right to free movement within the EU Single Market (Stan and Erne, 2021).…”