Experimenting European healthcare forward. Do institutional differences condition networked governance?

ABSTRACT

Despite increasing interdependencies, national decision-makers have been reluctant to delegate healthcare competences to the supranational level in the European Union (EU). To overcome this impasse, EU institutions and member states have agreed on middle ground compromises by means of experimentalist governance. In this paper, we examine a tool of experimentalist governance in the making, i.e., the network formed by the cross-border healthcare expert group (CBHC) in the Patient Rights Directive. We ask whether interaction by means of transitive relations carrying trust, takes place and the extent to which domestic institutions, i.e., healthcare models, condition such interaction and thus learning. To examine network interactions, we use social network analysis on the basis of collected survey data on the exchange of information, advice and best practices within the CBHC network. We develop an Exponential Random Graph Model of the network to test the extent to which domestic institutions condition such interactions. For this, we conduct a cluster analysis and build a healthcare typology of EU27 plus the UK, Norway and Iceland, identifying five distinct healthcare types. We find that this type of networked governance brings EU healthcare cooperation forward, while domestic institutions greatly condition who interacts with and learns from whom.

KEYWORDS:

• European Union
• Experimentalist governance
• Social network analysis
• Crossborder healthcare
• Healthcare typology
• Interaction
• Trust
• Learning

Disclosure statement

No potential conflict of interest was reported by the author(s).

Notes

1 Directive 2011/24/EU of the European Parliament and of the Council of 9 March 2011 on the application of patients’ rights in cross-border healthcare.

2 In network theory, the concept of transitivity operationalizes social trust as: If A chooses B and B chooses C, A tends to choose C also.

3 See article 1, section 1 of the directive.

4 Ibidem

5 See article 12 of the directive.

6 See article 15 of the directive.

7 See article 16 of the directive.

8 See ‘Rules of Procedure of the Cross-Border Healthcare Expert Group’, Ref. Ares (2017) 414436 - 26/01/2017.

9 Croatia, Iceland, Spain and the United Kingdom are missing.

10 The year 2016 provides the most complete and up-to-date data for each member state. The following Eurostat tables were used: hlth_sha11;_hf, tepsr_sp310; hlth_sha11_hc; hlth_staff; hlth_facil.

11 A GP is paid a fixed amount for every patient registered with him or her.

12 While the data as collected by the Commission do not give a complete overview of patient mobility and Germany, Cyprus, Netherlands, Sweden and Iceland were not able to report any data on patient flows, this is the best possible source of data we could find.

Additional information

Funding

The research for this article was funded by the Danish Council for Independent Research [Grant no DFF-7015-00024].

Notes on contributors

Dorte Sindbjerg Martinsen

Dorte Sindbjerg Martinsen is professor at the Department of Political Science, University of Copenhagen.

Reini Schrama

Reini Schrama is postdoctoral researcher at the Department of Political Science, University of Copenhagen.

Ellen Mastenbroek

Ellen Mastenbroek is professor at the Public Administration Department, Radboud University.