Towards a European Health Union: What Role for Member States?

Abstract

Calls for a European Health Union apparently challenge long-standing beliefs that national healthcare system organisation is a Member State competence. Interaction between Member State and European Union (EU) levels therefore fundamentally requires reflection in the design, overall structure and legal basis of any European Health Union. Article 168(7) Treaty on the Functioning of the European Union (TFEU) provides the current version of the seemingly limited EU competence with regards to national healthcare system organisation and has received surprisingly little attention thus far. On the one hand, within the wider EU health competence ‘web’, Article 168(7) TFEU constrains EU adoption of measures incentivising Member States to use particular treatments or to increase intensive care units in response to COVID-19. On the other hand, Article 168(7) TFEU is challenged by the perceived influence of Country-Specific Recommendations issued in the context of the European Semester on national health policies. This opinion piece provides an original assessment of Article 168(7) TFEU to argue that Treaty change to redress the balance between EU and Member State competence regarding national healthcare systems may be uncalled for given both the flexibility afforded by the provision and the complexity and diversity of Member State healthcare systems.

The European Health Union: European Union’s Concern about Health for All. Concepts, Definition, and Scenarios

“…A new agency or executive coordinating structure should be created—the European Health Emergency Preparedness and Response Authority (HERA) [ 39 , 44 , 45 ]. According to the literature, new threats are to come and better preparation is necessary [ 46 , 47 , 48 , 49 ]. As a consequence, the EU requires better pandemic preparedness, risk assessment and surveillance as well as data sharing [ 44 , 45 , 47 , 50 , 51 , 52 ].…”

“…The EU4Health Policy framework reminds that “a high level of health human protection is to be ensured in the definition and implementation of all Union policies and activities”, making health a question for the whole European governance as a whole following the application of the HiAP principle [ 53 ]. Innovative solutions could be applied as defining public health as a cross-border problem [ 12 , 42 , 48 , 49 ]. Institutionally, innovation is needed as well [ 52 ].…”

The emergence of post‐Westphalian health governance during the Covid‐19 pandemic: the European Health Union

“…This might be a way for the EU to gain further traction in health policy, starting with pandemic preparedness during the Covid‐19 crisis. Although EU member states remain in control of health policy overall, there are possibilities for differentiated integration with member states taking different routes depending on their needs and preferences (Guy, 2020 ).…”

The State of the Health (Dis)-Union in the EU: the legacy of austerity under the trial of Covid-19

“…From this partial portrait, we can quickly see substantial inequalities and disparities within the European Union, prevalently along the centre-periphery divide. Among the measures included in European Semester, the Country-Specific Recommendations are built to harmonise and monitor Member States performances in defined policy fields -that could be considered as a 'powerful soft law' instrument (Guy, 2020;Azzopardi-Muscat et al, 2015) able to set standards and benchmarks. The CSRs assumed a peculiar role after the sovereign debt crisis, monitoring commonly agreed budget policies with measures mainly addressed to social matters, growth and investments, always considering public budget contingencies.…”