The making of a European healthcare union: a federalist perspective

ABSTRACT

European Union (EU) involvement in healthcare policies is growing, despite the fact that national governments prefer to keep an almost exclusive say in these policies. This article explains how this shift of authority could happen and explores whether it will lead to a European healthcare union. It argues that federalism offers the most fruitful way to do so because of its sensitivity to the EU's institutional settings and to the territorial dimension of politics. The division of competences and national diversity of healthcare systems have been major obstacles for the formation of a healthcare union. However, the EU obtained a role in healthcare through the impact of non-healthcare legislation, voluntary co-operation, court rulings, governments’ joint-decision traps and fiscal stress of member states. The emerging European healthcare union is a system of co-operative federalism without much cost-sharing. The healthcare union's robustness is limited, also because it does not generate much loyalty towards the EU.

KEY WORDS:

• European integration
• federalism
• healthcare
• joint-decision trap
• patients’ rights directive

ACKNOWLEDGEMENTS

Financial support from the Danish Research Council project no. 10-079675/FSE is gratefully acknowledged. We would like to thank Thomas Kostera, Scott Greer, Paul Robben, Tamara Hervey, the three anonymous referees and the participants of the panel ‘Welfare Federalism in the Making? Welfare Policies, Member States and the EU' at the ECPR General Conference in Bordeaux (2013), of the Governance session of the Institute of Health Policy and Management of the Erasmus University Rotterdam (2013) and of the workshop ‘Cross-border Healthcare Law in the European Union: Current Status and Implications'(2014) in Copenhagen for their valuable comments on previous versions of this article.

Additional information

Notes on contributors

Hans Vollaard

Biographical notes

Hans Vollaard is lecturer in Dutch and European politics at the Political Science Department of Leiden University, the Netherlands.

Hester van de Bovenkamp

Hester van de Bovenkamp is assistant professor of public administration at the institute of Health Policy and Management of the Erasmus University Rotterdam, the Netherlands.

Dorte Sindbjerg Martinsen

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