Spot Markets and Bureaucratic Warfare: Promises, Perils, and Policies in EU Healthcare Services

Abstract

The nascent global market in health services has reached a crucial point. While rising numbers of patients are seeking cheaper care abroad, and migratory flows of professionals underpin and erode the health systems of different countries, there is no international regulatory framework capable of managing the risks of such professional mobility and medical tourism. On a range of regulatory questions -from professional accreditation to aftercare to medical liability- patients, professionals and policymakers are operating largely in the dark. What is happening, and what does it mean for health systems?

Studying the European Union can shed light on this issue. In the process of creating its own internal services market, the EU has been forced to deal with these issues sooner than most political systems. A series of decisions made by the European Court of Justice made it very clear that health could be subject to the same EU laws and market principles as any other tradable service, obliging member states to create a truly European health policy that could mitigate the potential damage from these rulings to member states’ health systems. The resulting policy architecture may be the most advanced policy experiment we can point to in crossborder health services regulation, but it is a piecemeal approach rather than a comprehensive solution (Jarman & Greer 2010).

This paper reflects on the existing regulatory structure in EU health services with the aim of drawing some theoretical and practical insights for future public health policymaking. Our argument proceeds as follows. The first section presents the current state of European Union health policy, focusing on healthcare services policy. We argue that EU health policy as it stands is more about markets than it is about health outcomes, and remains so after over a decade of effort by policymakers. The second section explores the reasons for this, discussing the risks that EU healthcare policy presents to policymakers. Two sets of risks are analyzed: the risks associated with the free movement of patients and professionals, and those associated with the possibility of EU-driven deregulation. The third section argues that policymakers have adopted defensive strategies towards EU health policy, attempting to manage the risks to their own health systems. These strategies include the use of spot markets, calls for ‘legal certainty’, increased caution by the Court, and minimalist implementation on the part of member state officials.