Inside the black box: The EU’s economic surveillance of national healthcare systems

Abstract

In the context of macro-economic surveillance, the European Union(EU) increasingly addresses national health system reform. Member States receiving financial assistance are required to implement detailed reforms stipulated in 'Memorandums of Understanding' (MoUs). But the health systems in other (non-MoU) countries are also scrutinised in the context of the 'European Semester': through this annual policy cycle, the EU has continuously strengthened the tools it uses to enforce compliance. This article aims to open the black box of the EU's economic surveillance of national healthcare systems by outlining the complex policy architecture of the EU's newly acquired role in this area. The story of how health has emerged on the European agenda illustrates how the Eurozone crisis created a policy 'window of opportunity' to push through fiscal surveillance of health systems as part of the solution to the crisis. The cognitive frameworks put forward by certain elites added up to the primacy of an economic perspective over health objectives. Finally, our analysis of the role of the actors involved in the elaboration of EU guidance in the field of health points to the dominance of 'economic' actors and relative absence of 'health' actors, in spite of increased attempts by the latter to gain influence.

The rise of a European healthcare union

“…Kingdon's multiple streams approach, or variations of it, can still be helpful to explain whether a European healthcare union may yet emerge in the organized chaos of the EU despite a Eurosceptic mood (see also Vollaard and Martinsen 2014;Baeten and Vanhercke 2016). …”

Health system governance in Europe

“…The issues of sustainable finances and investments in health system have received increasingly attention at the European level as a response to the financial crisis. The European Commission has included health related Country Specific Recommendations in its European Semester Process since 2010 (Azzopardi- Baeten & Vanhercke, 2017). In 2012, the Commission established an Expert Panel on Effective ways to invest in Health to provide advice for health investments 21 .…”

“…As such, the chapter concludes that the analysed tools used by the European Commission to support cooperation and innovation to alleviate crisis effects in national health system "are not neutral". Moreover, in how far those tools can effectively support problem solving in Member States, has been questioned given the strong subsidiarity principle in place for health systems and the predominant financial consolidation rationale at EU level (Azzopardi- Baeten & Vanhercke, 2017). policy tools and the effects on health system goals .…”

“…Access and quality issues being less frequently addressed (Azzopardi- . Lately, an analysis of how the CSRs come into being reveals that economic perspectives and actors are dominating the process (Baeten & Vanhercke, 2017). It will remain open, so far, how national reform programmes informed by the CSRs will be taken up by Member States and how it will change the health system reform agendas given CSRs are developed in collaboration with Member States from early onwards.…”

“…An increased involvement of national health policy actors at EU level would strengthen the role of health actors at EU level vis-a-vis other players. A stronger voice of health actors is needed especially in the context of the European Semester and the Country Specific Recommendations (Azzopardi- Baeten & Vanhercke, 2017).…”