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Building a European care regime: EU governance of national care provision through the European Semester

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Abstract
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This study explores how the European Union (EU) governs care provision in member states through the European Semester and its Country-Specific Recommendations (CSRs). Introduced after the economic crisis, the Semester has became a targeted tool for shaping national care policies and regimes, complementing EU measures like family leave directives and childcare targets. Our qualitative analysis of CSRs from 2011–2024, focused on policy orientations and policy frames, shows that the European Semester has been pivotal in the EU’s strategy to shape care policies and systems in member states—a field that belongs to member state competences but is essential to the EU’s social and economic objectives. The European Commission has consistently used the Semester to encourage care-related reforms. While social investment frame aimed at promoting women’s employment is prominent, a cost-cutting approach implying market solutions and family responsibilities remains strong for long-term care. We suggest that the European Semester aims to align national care regimes, fostering a European model based on a fiscally sustainable balance between unpaid care provided by families and care provided by states and markets and underpinned by a commodifying script.

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Background The European Semester (ES) is a policy coordination and scrutiny framework at EU-level for surveillance of fiscal and macro-economic policies in Member States. Health systems have not evaded that scrutiny. The analysis focusses on how health systems reforms are being endorsed in Country Specific Recommendations (CSRs) and how the ES process links to planning and implementation of national health system reforms over the period 2015-2018. Methods A descriptive content analysis of CSRs with a search for the keywords and phrases ‘health’, OR ‘healthcare’, OR ‘long-term care’ was performed for the years 2015-2018. Furthermore, CSRs addressing health systems were classified according to whether they were targeting access, quality or sustainability; and categorized regarding organisation and governance, financing, physical and human resources, and provision of services. Finally, implementation progress on the health CSRs was rated according to EC’s own evaluation scheme derived from the preceding year’s country report. Results CSRs with health system recommendations have featured continuously in the ES process each year and have stabilised in number. The themes of health CSRs are still dominated by financial sustainability, cost-effectiveness and of financing, although other health system goals and domains, particularly access, are increasingly addressed. There is a high degree of consistency on the content of health CSRs over the years for each country addressed. Progress with implementation of health CSRs is disappointing so far, based on the EC evaluations. No clear link between discontinuation of health CSRs and evidence of progress in implementing the CSR can be discerned. Conclusions The results uncovered some of the links between national and European institutions leveraging the ES to push health system reforms. However, a more balanced and long-term view is needed for the ES to contribute solidly to complementing national efforts in a complex reform context. Key messages Health CSRs are still dominated by financial sustainability considerations while other health system goals and domains are increasingly addressed. Progress with implementation of health CSRs is disappointing so far, although a longer-term perspective is needed to pay tribute to the complex reform environment of health system reforms.

  • Front Matter
  • Cite Count Icon 166
  • 10.1080/13501763.2017.1363807
Introduction: the European Semester as a new architecture of EU socioeconomic governance in theory and practice
  • Aug 29, 2017
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  • Amy Verdun + 1 more

ABSTRACTThe ‘European Semester’, a new framework for policy co-ordination across European Union (EU) member states, represents a major step in EU governance. Created in 2010 in the wake of the financial and sovereign debt crises and revamped in 2015, it was intended to provide a new socioeconomic governance architecture to co-ordinate national policies without transferring full sovereignty to the EU level. This introduction offers a brief overview and assessment of the European Semester, examining its implications along three critical axes, running respectively between the economic and the social, the supranational and the intergovernmental, and the technocratic and democratic poles of EU governance. We introduce and briefly summarize the seven other contributions that make up this collection. Our conclusions are that the European Semester challenges established theoretical understandings of EU governance, as it is a prime example of the complexity that supersedes simple polar oppositions.

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