The Europeanisation of national health care systems: creative adaptation in the shadow of patient mobility case law

This paper examines the actual (as opposed to potential) impact of European Integration on national health care systems as a result of rulings of the European Court of Justice (ECJ) with regard to patient mobility. These rulings provoked a number of similar but far from identical responses across the Member States. Adaptation processes are indeed not straightforward. Member States, confronted with the deregulatory dynamic of the applications of the free movement rules, try to uphold their steering instruments as much as they can, whilst allowing patients to be treated abroad. This empirically driven paper provides a detailed assessment of how the Europeanisation of health care systems through ECJ cases sets off a dynamic process of creative adaptation at the national level. Through leverage (and some learning) actors alter the policies and politics of domestic health care systems. Factors that may explain the considerable differences between the reactions of Member States - also between Member States with similar health systems - include the likelihood of an exodus of patients, the compatibility between the European Union Law (EU) and national health care systems as well as the presence of reforms in the domestic system. The process of creative responses to EU law includes – for Member States confronted with long waiting lists – attempts to reduce the demand for exit, for example through contracting the domestic commercial sector. The study furthermore shows the agency by domestic actors who draw legitimacy from the EU setting to reinforce their position (or acquire one) at the national level. It thereby confirms the assertion that the effects of these ECJ rulings regarding patient mobility go beyond the narrow issue of patient mobility itself and that it can have an important impact on the domestic health care systems