When Europa meets Bismarck: cross-border healthcare and usages of Europe in the Austrian healthcare system

• Main Author: Kostera, Thomas
• Other Authors: Foret, François
• Format: Doctoral Thesis
• Language: en
• Published: Universite Libre de Bruxelles 2014
• Subjects: Science politique générale; European federation; Medical care > European Union countries; Medical policy > European Union countries; Medical care > Austria; Medical policy > Austria; Construction européenne; Soins médicaux > Pays de l'Union européenne; Politique sanitaire > Pays de l'Union européenne; Soins médicaux > Autriche; Politique sanitaire > Autriche; Europe > History > 19th century; Europe > History > 20th century; Europe > Histoire > 19e siècle; Europe > Histoire > 20e siècle; Europeanization; Historical Institutionalism; Usages of Europe; Regional Policy; Healthcare; Austria
• Online Access: http://hdl.handle.net/2013/ULB-DIPOT:oai:dipot.ulb.ac.be:2013/209268

In a series of landmark rulings on patient mobility and cross-border healthcare, the European Court of Justice (ECJ) has made clear that Member States’ healthcare systems have to comply with the rules of the EU’s Internal Market when it comes to individual patient rights and the non-discrimination of healthcare providers. The rulings increased the possibilities for EU Member State citizens to get medical treatment in another Member State (“cross-border healthcare”), yet providing that under certain conditions the home Member State has to pay for these treatments in the other country. After a decade of negotiations, these rulings have been codified in a European Directive. Assuming that European integration has an impact on national welfare states and taking the example of European rules on access to cross-border healthcare, this thesis suggests analyzes the domestic impact of European integration in terms of Europeanization of the Austrian healthcare system within the context of the interplay between actors’ interests and practices on the one hand, and institutional effects on the other. European cross-border healthcare in forms of regional projects and privately or publicly organized healthcare arrangements has already become a reality in many European countries, especially in border regions. The main research questions which guides this thesis can be be put as follows: How does European integration in healthcare impact on the interests, practices and strategies of national actors that operate between national institutional constraints and European opportunities? And if national actors’ interests and strategies change, does this in turn have repercussions on the national institutional rules of healthcare governance? Given that European integration in healthcare delivery is a rather a “recent” phenomenon, and based on the assumption that actors’ strategies change more easily than national institutions, the following hypothesis is tested: Even if national healthcare actors use Europe – and hence their practices and strategies change – their interests remain largely determined by the national institutional set-up of the healthcare system. The institutional boundaries of the national healthcare system may have become porous, but for the time being they remain intact. The main findings of this study confirm the hypothesis and can be summarized as follows: Austrian actors responsible for the delivery of healthcare actively integrate various usages Europe into their existing practices of healthcare governance. These usages of Europe are more frequent at European level than at national level. Those actors who have important legal competencies, financial resources, and hence power in healthcare governance at national level, are also in a better position to use Europe effectively than those actors who lack such national resources. Limited usages of Europe at national level by corporate actors can best be accounted for by practices of consensually governing a typically Bismarckian healthcare system. None of the actors analysed, no matter how critical their stance vis-à-vis their own healthcare system might be, puts into question the legitimacy of the national healthcare system in the light of increased European competencies in regulating cross-border healthcare. Advancing European integration, mainly through the ECJ’s rulings on cross-border healthcare, might have rendered national institutional boundaries porous, but national institutions retain – at least for the time being – their power of channelling actors’ interests and of influencing corresponding practices of healthcare governance. These results invite us to further investigate which kind of healthcare governance structures are being developed at European level in parallel to those existing at national level, and to what extent Bismarckian welfare regimes might be showing resistance to institutional change induced by European integration. === Doctorat en Sciences politiques et sociales === info:eu-repo/semantics/nonPublished