Europeanizing Healthcare: Cross-border Patient Mobility and Its Consequences for the German and Danish Healthcare Systems. Bruges Political Research Paper No. 7, May 2008

摘要

Member States have been trying to shield their welfare systems from European integration. Yet, as the recent European Court of Justice’s ruling on the Watts case has shown, Member States’ healthcare systems have to comply with the fundamental principles of the European Single Market. The obstacles to undergo non-emergency medical treatment in other Member States have been significantly reduced for European citizens. This paper analyzes how Member States’ healthcare systems have been affected by the development of European cross-border patient mobility using the concept of Europeanization. Drawing on Historical Institutionalism, it is argued that a process of institutional adaptation will occur in which the pace and the scale of the transposition of European legislation to domestic legislation depend on its fit with existing domestic institutions. Depending on their institutional set-ups, Germany’s social insurance system will show a lower degree of institutional misfit than Denmark’s national health system. Therefore Germany will try to upload different policy preferences to the European level than Denmark in order to lower the costs of their institutional adaptation to European obligations. It turns out that national health systems show a higher institutional misfit than social insurance systems: the costs of institutional adaptation are much higher for Denmark than for Germany. Hence, Denmark has been slower in transposing European legislation into national law than Germany. Conversely, Germany tries to upload different policy preferences to the European level than Denmark in order to lower the costs of their institutional adaptation to European obligations. The political preferences and interests that the Member States are trying to upload differ as much as their adaptive pressures. A restrictive interpretation of the Court’s jurisprudence is of much more importance to Denmark than to Germany, as Germany just tries to avoid further adaptive pressures.