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

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Comparative European Politics Aims and scope

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.

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Notes

  1. Article 168,7° of the Treaty on the Functioning of the European Union.

  2. Council Regulation (EC) 1466/97; Council Regulation (EC) 1467/97; Council Regulation (EC) 479/2009; Regulation (EU) No 1173/2011 and Directive 2011/85/EU.

  3. Regulation (EU) No 472/2013 and Regulation (EU) No 473/2013.

  4. Treaty on Stability, Coordination and Governance in the Economic and Monetary Union, between the Kingdom of Belgium, the Republic of Bulgaria, the Kingdom of Denmark, the Federal Republic of Germany, the Republic of Estonia, Ireland, the Hellenic Republic, the Kingdom of Spain, the French Republic, the Italian Republic, the Republic of Cyprus, the Republic of Latvia, the Republic of Lithuania, the Grand Duchy of Luxembourg, Hungary, Malta, the Kingdom of the Netherlands, the Republic of Austria, the Republic of Poland, the Portuguese Republic, Romania, the Republic of Slovenia, the Slovak Republic, the Republic of Finland and the Kindom of Sweden, Brussels, 2 March 2012.

  5. The European Structural and Investment Funds are: European Regional Development Fund (ERDF), European Social Fund (ESF), Cohesion Fund (CF), European Agricultural Fund for Rural Development (EAFRD) and the European Maritime and Fisheries Fund.

  6. The EPC contributes to the work of the Economic and Financial Affairs (ECOFIN) Council and the Commission by developing analysis and policy consensus.

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Baeten, R., Vanhercke, B. Inside the black box: The EU’s economic surveillance of national healthcare systems. Comp Eur Polit 15, 478–497 (2017). https://doi.org/10.1057/cep.2016.10

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