Europeanising Healthcare: The Effects of European Integration on Domestic Systems

Abstract

Over recent decades, the structure and role of the European Union has developed and evolved. Scholars claim that EU jurisdiction and policy have expanded in many areas, such as agriculture, monetary, and competition policy, shifting from the domestic level to the supranational, the EU level. A debate has emerged on the nature of this European change and its implication for the Member States of the EU. Alongside this trend, new pressures and challenges emerge that are affecting both domestic welfare states and healthcare systems. A complex interplay results involving Europeanisation of domestic healthcare systems.

This thesis reviews the literature and seeks to contribute to the understanding of the development of healthcare systems and the role that the EU plays. It seeks to help answer: to what degree does European integration affect domestic healthcare systems? How and when do pressures created by the EU alter domestic healthcare systems? What is the nature of such change is it uniform, varied, or differential across Member States systems? Do these impacts vary by EU policy type? How do domestic institutions and actors influence this process of Europeanisation across varied healthcare system arrangements? What insights does the interaction of EU policy and domestic systems provide to us about the Europeanisation process and healthcare institutional change over time? How have recent developments affected the Europeanisation process?

There are three main contributions of this thesis. The first contribution is to provide an overview of four bodies of literature the welfare state, health policy, Europeanisation of domestic systems, and EU health policy literature and test insights from this literature. The second main contribution is the addition of new data, including interview findings, and case study analysis to the field relating to the Europeanisation of healthcare. The third contribution is to construct and test a theoretical framework that summarises the generalisable impact of European integration across countries while accounting for varied domestic institutional arrangements. The model is dynamic and rooted in the literature reviewed.

The thesis provides a qualitative analysis of three case studies in the EU Germany, Ireland and Spain. It comprises of original interview data with domestic actors that were conducted for the thesis. The data from these interviews is then used to frame the detailed case study analysis. The examination of the dynamics and developments in these three countries is used to test the explanatory framework outlined by the thesis.

This thesis constructs and tests a theoretical framework that outlines the types of EU policy affecting healthcare, explains the impact of Europeanisation across diverse healthcare systems, and lays out how domestic institutional arrangements influence this effect through four explanatory component arguments. The thesis illustrates the varied role of the EU in domestic healthcare system development through case study analysis. Findings pertaining to the effects of external and evolving pressures, such as the EU, can improve the understanding of the development of domestic healthcare systems. The insights can be applied to practice in order to understand future trends and reform.