In the current context of reaching budget deficit targets that is pushed by the European Union, this article looks at the impacts on health systems. With new legislation on economic governance, for the first time, the European Union has a bigger role in health systems at national level. The article explores the role for stakeholders, provides examples of successful European Union collaboration and upcoming initiatives in economic governance. The article makes the economic case used by health advocates to the importance of considering health expenditure as an investment and considers the role for health systems in society.