EU Health Policy: To What Extent the EU Got Involved in the Field of Health?

Introduction

This study analyses the influence of the European Union (EU) on health policies of the member states. Despite the common belief; health care systems in member states are not apart from EU impact (Hervey & McHale, Health law and the European Union, 2004). The clear statements of Article 168 of the Lisbon Treaty, which underlines health as an area of national governments’ competence, and the inherent implication of the subsidiarity, do not mean that health is excluded from EU interference. The 1998 Kohll and Decker cases¹ have opened the way for many EU citizens seek health treatment elsewhere their home countries as a right entailed from European Community rules for free movement of goods and services. These cases have shown that health policy, although it is stated otherwise in the Treaties, cannot escape from the free movement rules of the EU. Thus, maybe not empowered by the treaties, the EU got involved in the health area. The level of EU’s competences in the health field and new pressures in the area of health from the EU after the Kohll and Decker cases are the two main questions of this paper concerned. In answering such questions, it have to be considered that there are three EU policy types i.e. Market building policies, which are regulatory usually and leaded by EU institutions, e.g. internal market, commercial policy ; market correcting policies, which aims to avoid negative impacts of market forces on citizens and producers and generally subject to intergovernmental bargaining, e.g. common agricultural policy; and finally there are also market-cushioning policies, that are also regulatory and having intention to decrease the loss given to individuals by economic activities of which the competences in this policy type are shared between EU and member states, e.g. environmental policy and social and health policies (Sbragia & Stolfi, 2008). Economic integration has started with market building policies, however through the time some unexpected and negative effects of integration have been addressed by market correcting and cushioning policies.

Health Policy in the EU faces a serious dichotomy. On the one hand the Treaty explicitly states that the area of Health is specifically within the responsibility of national governments (EC, 2009); on the other hand health systems of member states are dealing with people (e.g. professionals and patients), goods (e.g. medicines and medical devices) and services (e.g. insurance systems) which have been granted free movement by the same treaty (EC, 2009). So, many of the health systems of the national governments are subject to EU law and policy. In buying or selling pharmaceuticals or medical devices or recruiting health professionals the decisions are mainly made according to EU policies. Moreover, the citizens of the member states may travel to other member states and get their treatments there and their expenses would be refunded by their national authority; thus, the national health systems are officially excluded from the EU competence, however, they are subject to EU law in the fields of financing, delivery and provisions. Additionally, the EU has been bounded by the 1992 Maastricht Treaty “to contribute to the attainment of a high level of health protection” for the citizens of the EU. The question of how the EU executives expected to provide measures to comply with this treaty provision without being involved in the health policies of the national governments remains unanswered. The EU thus faces a challenge of either promoting free movements for the sake of integration or recedes from health policies to let member states to provide more social security (Scharpf, 2002). However, as it is in the case of health policy area, the EU can expand its influence in areas which have not been exclusively defined in EU competences standing on the rules stated in the EC Treaty. Furthermore, the EU does not want to leave health policy to the market forces, instead the commission tried, for example, to issue directives in the years of 2006 and 2008 about patient mobility, however, these initiatives did not welcome by some of the member states and those directives could not have been adopted.