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The implementation of European Union (EU) rules on cross-border care: moving towards convergence?

Published online by Cambridge University Press:  30 August 2018

Zuzana Nordeng  and
Frode Veggeland
Zuzana Nordeng*
Affiliation:
Researcher, Western Norway Research Institute, Sogndal, Norway
Frode Veggeland
Affiliation:
Professor, Department of Health Management and Health Economics, Institute of Health and Society, Faculty of Medicine, University of Oslo, Norway Norwegian Institute of Bioeconomy Research (NIBIO), Ås, Norway
*
*Correspondence to: Zuzana Nordeng, Researcher, Western Norway Research Institute, Vestlandsforsking, Postboks 163, 6851Sogndal, Norway. Email: [email protected], [email protected]
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Abstract

This article studies the implementation of the European Union (EU)’s Patients’ Rights Directive in Germany and Norway. The objective of the Directive was to allow EU member states to have a say in the regulatory work, ensure predictability and uniformity in the application of EU rules on cross-border care, and enhance a move towards EU harmonisation in this area. So far, the implementation processes in Norway and Germany have mixed results regarding the likelihood of achieving uniformity and harmonisation. Although the Directive has had convergent effects on certain areas of cross-border care, such as setting up National Contact Points and providing patients with the basic right to treatment abroad, implementation also shows divergent patterns. In both countries, adapting to EU rules has strengthened patients’ rights to choose freely among health-service providers in a wider European health-service market. However, due to legal discretion and country-specific institutions within which the new rules are applied, divergent patterns prevail.

Keywords

convergencecross-border careEUs patients’ rights directiveGermanyimplementationNorway
Type
Articles
Information
Health Economics, Policy and Law , Volume 15 , Issue 2 , April 2020 , pp. 141 - 159
Copyright
© Cambridge University Press 2018

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References

Baeten, R (2014) Cross-border patient mobility in the European Union: in search of benefits from the new legal framework. Journal of Health Services Research & Policy 19(4), 195–197.CrossRefGoogle ScholarPubMed
Böhm K, Schmid A, Götze R, Landwehr C and Rothgang H (2013) Five types of OECD healthcare systems: empirical results of a deductive classification. Health Policy 113(3), 258-269.CrossRefGoogle Scholar
Bremische Burgerschaft (2013) Bremisches Gesetz Zur Umsetzung Der Richtlinie 2011/24/EU Des Europäischen Parlaments Und Des Rates Vom 9. März 2011 Über Die Ausübung Der Patientenrechte in Der Grenzüberschreitenden Gesundheitsversorgung (Bremisches Patientenmobilitätsumsetzungsgesetz – BremPatMobUG). https://www.bremische-buergerschaft.de/drs_abo/2013-12-18_Drs-18-1215_8b745.pdf [5 March 2018].Google Scholar
Busse, R and Blümel, M (2014) Germany: health system review. Health Systems in Transition 16(2), 1–296.Google ScholarPubMed
Colombo, F and Tapay, N (2004) Private health insurance in OECD countries. OECD Health Working Papers No. 15, Paris: OECD. http://www.oecd-ilibrary.org/social-issues-migration-health/private-health-insurance-in-oecd-countries_527211067757 [2 May 2015].Google Scholar
Cucic, S (2000) European Union health policy and its implications for national convergence. International Journal for Quality in Health Care 12(3), 217–225.CrossRefGoogle ScholarPubMed
Crossman A (2016) What Is a Snowball Sample in Sociology? http://sociology.about.com/od/Types-of-Samples/a/Snowball-Sample.htm [2 February 2017].Google Scholar
Deutscher Bundestag (2003) Gesetz Zur Modernisierung Der Gesetzlichen Krankenversicherung. https://www.aerzteblatt.de/download/files/2004/07/x0001222.pdf [2 May 2015].Google Scholar
EFTA (2016) AGREEMENT ON THE – EEAagreement.pdf. http://www.efta.int/media/documents/legal-texts/eea/the-eea-agreement/Main%20Text%20of%20the%20Agreement/EEAagreement.pdf [27 December 2016].Google Scholar
EFTA Surveillance Authority (ESA) (2014) Letter of formal notice to Norway concerning the criteria for access to in-patient treatment in other EEA states – breach of Article 20 of Regulation 883/2004 and/or Article 36 EEA. http://www.eftasurv.int/media/public-documents/692126.pdf [15 May 2015].Google Scholar
EFTA Surveillance Authority (ESA) (2016) Hospital treatment in other EEA states. http://www.eftasurv.int/internal-market-affairs/articles/nr/2260## [25 April 2016].Google Scholar
European Commission (2015a) List of the national implementing measures notified to the European Commission. [24 April 2015].Google Scholar
European Commission (2015b) Member state data on cross-border healthcare following directive 2011/24/EU year 2015. http://ec.europa.eu/health//sites/health/files/cross_border_care/docs/2015_msdata_en.pdf [27 December 2016].Google Scholar
European Commission (2015c) Special Eurobarometer 425: patients’ rights in cross-border healthcare in the European Union. http://ec.europa.eu/public_opinion/archives/eb_special_439_420_en.htm#425 [3 June 2015].Google Scholar
European Commission (2016) Types of EU Law. https://ec.europa.eu/info/law/law-making-process/types-eu-law_en## [27 December 2016].Google Scholar
European Commission (2017) Health. http://europa.eu/rapid/press-release_IP-96-872_en.htm [20 November 2017].Google Scholar
European Commission representative (2015) Personal Communication.Google Scholar
European Court of Justice (ECJ) (1998) Press Release No 26/98: community nationals may obtain medical treatment in another member state and be reimbursed in accordance with the tariffs of the state in which they are insured. http://curia.europa.eu/en/actu/communiques/cp98/cp9826en.htm [3 February 2016].Google Scholar
European Parliament and the European Council (2011) Directive 2011/24/EU of the European Parliament and of the Council of 9 March 2011 on the application of patients’ rights in cross-border healthcare – LexUriServ.do. http://eur-lex.europa.eu/LexUriServ/LexUriServ.do?uri=OJ:L:2011:088:0045:0065:en:PDF [25 September 2014].Google Scholar
Gerlinger, T and Schmucker, R (2009) A long farewell to the Bismarck system: incremental change in the German health insurance system. German Policy Studies 5(1), 3–20.Google Scholar
German National Contact Point for Cross-Border Healthcare (2016) Who pays for treatment in EU member states?. http://www.eu-patienten.de/en/behandlung_ausland/geplante_behandlung_1/kostentraeger_eu/kostentraeger_eu.jsp [27 December 2016].Google Scholar
Goscinska, D (2014) Transposition of the Patients’ Rights Directive 2011/24/EU: a discourse analysis in Germany, Poland and Austria. Working Papers in Health Policy and Management, Volume 8, February. Berlin: Department of Health Care and Management, Universitätsverlag der TU Berlin. https://www.mig.tu-Berlin.de/fileadmin/a38331600/2014.publications/Working_Paper_vol.8.pdf [27 December 2016].Google Scholar
Greer, SL (2006) Uninvited Europeanization: neofunctionalism and the EU in health policy. Journal of European Public Policy 13(1), 134–152.CrossRefGoogle Scholar
Greer, SL (2008) Choosing paths in European Union health services policy: a political analysis of a critical juncture. Journal of European Social Policy 18(3), 219–231.CrossRefGoogle Scholar
Greer, SL (2011) The weakness of strong policies and the strength of weak policies: law, experimentalist governance, and supporting coalitions in European Union Health Care Policy. Regulation & Governance 5(2), 187–203.CrossRefGoogle Scholar
Greer, SL (2013) Avoiding another directive: the unstable politics of European Union cross-border health care law. Health Economics, Policy and Law 8(4), 415–421.CrossRefGoogle ScholarPubMed
Heichel, S, Pape, J and Sommerer, T (2005) Is there convergence in convergence research? An overview of empirical studies on policy convergence. Journal of European Public Policy 12(5), 817–840.CrossRefGoogle Scholar
Hervey, TK and McHale, JV (2015), European Union Health Law: Themes and Implications Cambridge: Cambridge University Press.CrossRefGoogle Scholar
Holzinger, K and Knill, C (2005) Causes and conditions of cross-national policy convergence. Journal of European Public Policy 12(5), 775–796.CrossRefGoogle Scholar
Jordan, A (2005) Policy convergence: a passing fad or a new integrating focus in European Union Studies?. Journal of European Public Policy 12(5), 944–953.CrossRefGoogle Scholar
Kelemen, RD (2011), Eurolegalism: The Transformation of Law and Regulation in the European Union, Cambridge, MA: Harvard University Press.Google Scholar
Kifmann, M and Wagner, C (2014) Implications of the EU patients’ rights directive in cross-border healthcare on the German sickness fund system. in R Levaggi and M Montefori (eds) Health Care Provision and Patient Mobility. Health Integration in the European Union Milano: Springer, 49–66.CrossRefGoogle Scholar
Knill, C (2005) Introduction: cross-national policy convergence: concepts, approaches and explanatory factors. Journal of European Public Policy 12(5), 764–774.CrossRefGoogle Scholar
Knill, C and Lehmkuhl, D (2002) The national impact of European Union regulatory policy: three Europeanization mechanisms. European Journal of Political Research 41(2), 255–280.CrossRefGoogle Scholar
Ladrech, R (2010), Europeanization and National Politics Hampshire: Palgrave Macmillan.CrossRefGoogle Scholar
Legido-Quigley, H, Passarani, I, Knai, C, Busse, R, Palm, W, Wismar, M and McKee, M (2011) Cross-border healthcare in the European Union: clarifying patients’ rights. BMJ 342: d296.CrossRefGoogle ScholarPubMed
Lenschow, A, Liefferink, D and Veenman, S (2005) When the birds sing. A framework for analysing domestic factors behind policy convergence. Journal of European Public Policy 12(5), 797–816.CrossRefGoogle Scholar
Magnussen, J, Vrangbæk, K, Saltman, RB and Martinussen, PE (2009) The Nordic model of health care. in J Magnussen, K Vrangbæk and RB Saltman (eds) Nordic Health Care Systems: Recent Reforms and Current Policy Challenges: Recent Reforms and Current Policy Challenges Maidenhead: McGraw-Hill Education, 3–20.Google Scholar
Martinsen, DS (2009) Conflict and conflict management in the cross-border provision of healthcare services. West European Politics 32(4), 792–809.CrossRefGoogle Scholar
Martinsen, DS (2011) Judicial policy-making and Europeanization: the proportionality of national control and administrative discretion. Journal of European Public Policy 18(7), 944–961.CrossRefGoogle Scholar
Martinsen, DS (2015), An Ever More Powerful Court? The Political Constraints of Legal Integration in the European Union Oxford: Oxford University Press.CrossRefGoogle Scholar
Martinsen, DS and Blomqvist, P (2009) The European Union: single market pressures. in J Magnussen, K Vrangbæk and RB Saltman (eds) Nordic Health Care Systems: Recent Reforms and Current Policy Challenges: Recent Reforms and Current Policy Challenges Maidenhead: McGraw-Hill Education, 294–315.Google Scholar
Martinsen, DS and Vrangbæk, K (2008) The Europeanization of health care governance: implementing the market imperatives of Europe. Public Administration 86(1), 169–184.CrossRefGoogle Scholar
Mastenbroek, E and Kaeding, M (2006) Europeanization beyond the goodness of fit: domestic politics in the forefront. Comparative European Politics 4(4), 331–354.CrossRefGoogle Scholar
Mossialos, E and Palm, W (2003) The European Court of justice and the free movement of patients in the European Union. International Social Security Review 56(2), 3–29.CrossRefGoogle Scholar
Mossialos, E, Permanand, G, Baeten, R and Hervey, TK (2010) Health systems governance in Europe: the role of European Union Law and Policy. in E Mossialos, G Permanand, R Baeten and TK Hervey (eds) Health Systems Governance in Europe: The Role of European Union Law and Policy New York: Cambridge University Press, 1–83.CrossRefGoogle Scholar
Van den Noord, P, Hagen, T and Iversen, T (1998) The Norwegian health care system. OECD Economics Department Working Papers, No. 198, Paris: OECD Publishing. http://dx.doi.org/10.1787/571585217086 [15 May 2015].CrossRefGoogle Scholar
Norwegian Ministry of Foreign Affairs (2014) Prop. 135 S (2013–2014) – Regjeringen.no. https://www.regjeringen.no/no/dokumenter/Prop-135-S--20132014/id2000303/ [30 May 2015].CrossRefGoogle Scholar
Norwegian Ministry of Health and Care Services (2009) Norwegian position on the proposal for a directive on the application of patients’ rights in crossborder healthcare. https://www.regjeringen.no/globalassets/upload/hod/vedlegg/pm-pas-dir-03072009-e-m.pdf [30 May 2015].Google Scholar
Norwegian Ministry of Health and Care Services (2014) Grensekryssende Pasientrettigheter – Regjeringen.no. https://www.regjeringen.no/no/sub/eos-notatbasen/notatene/2008/juli/grensekryssende-pasientrettigheter/id2433855/ [30 May 2015].Google Scholar
Norwegian Parliament (2013) Parliamentary papers related to changes in legislation on patients’ and users’ rights. https://www.stortinget.no/%20no/Saker-og-publikasjoner/Saker/Sak/?p=57071 [30 May 2015].Google Scholar
Norwegian Parliament (2014) Parliamentary papers related to the decision on incorporating into the EEA agreement directive 2011/24/EU on the application of patients’ rights in cross-border health care. https://www.stortinget.no/no/Saker-og-publikasjoner/Saker/Sak/?p=60536Google Scholar
Obermaier, AJ (2009), The End of Territoriality?: The Impact of ECJ Rulings on British, German and French Social Policy, London and New York: Routledge, 119.Google Scholar
Olsen, JP (2002) The many faces of Europeanization. JCMS: Journal of Common Market Studies 40(5), 921–952.Google Scholar
Olsen, JP (2003) Towards a European administrative space?. Journal of European Public Policy 10(4), 506–531.CrossRefGoogle Scholar
Palm, W and Glinos, IA (2010) Enabling patient mobility in the EU: between free movement and coordination. in E Mossialos, G Permanand, R Baeten and TK Hervey (eds) Health Systems Governance in Europe: The Role of European Union Law and Policy New York: Cambridge University Press, 509–560.CrossRefGoogle Scholar
Pennings, F (2011) Cross-border health care directive: more free movement for citizens and more coherent EU law?. European Journal of Social Security 13(4), 424–452.CrossRefGoogle Scholar
Pollitt, C (2001) Clarifying convergence. Striking similarities and durable differences in public management reform. Public Management Review 3(4), 471–492.CrossRefGoogle Scholar
Radaelli, CM (2003) The Europeanization of public policy. in K Featherstone and CM Radaelli (eds) The Politics of Europeanization Oxford: Oxford University Press, 27–56.CrossRefGoogle Scholar
Santuari, A (2013) The European Union directive on the application of patients’ rights in cross-border healthcare. Journal of Public Health Research 2(1), 1.CrossRefGoogle ScholarPubMed
Sauter, W (2011) Harmonisation in healthcare: the EU patients’ rights directive. TILEC Discussion Paper No. 2011-030, 26. http://dx.doi.org/10.2139/ssrn.1859251CrossRefGoogle Scholar
Scharpf, FW (2010) The asymmetry of European integration, or why the EU cannot be a ‘social market economy’. Socio-Economic Review 8(2), 211–250.CrossRefGoogle Scholar
Vollaard, H and Martinsen, DS (2014) Bounded rationality in transposition processes: the case of the European patients’ rights directive. West European Politics 37(4), 711–731.CrossRefGoogle Scholar
Vollaard, H, van de Bovenkamp, H and Martinsen, DS (2016) The making of a European Healthcare union: a federalist perspective. Journal of European Public Policy 23(2), 157–176.CrossRefGoogle Scholar
Wessels, W (1996) Institutions of the EU system; models of explanation. In D Rometsch and W Wessels (eds) The European Union and Member States: Towards Institutional Fusion? Volume 2, Manchester and New York: Manchester University Press, 20–36.Google Scholar
Wismar, M, Palm, W, Figueras, J, Ernst, K and Van Ginneken, E (eds) (2011), Cross-border health care in the European Union: mapping and analysing practices and policies. Observatory Studies Series 22, European Observatory on Health Systems and Policies. Geneva: World Health Organization. http://www.euro.who.int/__data/assets/pdf_file/0004/135994/e94875.pdf [30 May 2015].Google Scholar