Abstract
BackgroundHealth systems are not considered to be significantly influenced by European Union (EU) policies given the subsidiarity principle. Yet, recent developments including the patients’ rights and cross-border directive (2011/24 EU), as well as measures taken following the financial crisis, appear to be increasing the EU’s influence on health systems. The aim of this study is to explore how health system Europeanisation is perceived by domestic stakeholders within a small state.MethodsA qualitative study was conducted in the Maltese health system using 33 semi-structured interviews. Inductive analysis was carried out with codes and themes being generated from the data.ResultsEU membership brought significant public health reforms, transformation in the regulation of medicines and development of specialised training for doctors. Health services financing and delivery were primarily unaffected. Stakeholders positively perceived improvements to the policy-making process, networking opportunities and capacity building as important benefits. However, the administrative burden and the EU’s tendency to adopt a ‘one size fits all’ approach posed considerable challenges. The lack of power and visibility for health policy at the EU level is a major disappointment. A strong desire exists for the EU to exercise a more effective role in ensuring access to affordable medicines and preventing non-communicable diseases. However, the EU’s interference with core health system values is strongly resisted.ConclusionsOverall domestic stakeholders have a positive outlook regarding their health system Europeanisation experience. Whilst welcoming further policy developments at the EU level, they believe that improved consideration must be given to the specificities of small health systems.
Highlights
Health systems are not considered to be significantly influenced by European Union (EU) policies given the subsidiarity principle
Domestic stakeholders in the Maltese health system are positive over the EU influence on their health system and desire greater EU involvement in health policy as long as the influence is flexible enough to take into account small state specificities
Establishing causality is a dilemma for researchers in the field of Europeanisation
Summary
Health systems are not considered to be significantly influenced by European Union (EU) policies given the subsidiarity principle. The EU has been described as exerting its influence on health systems through three main strands of activity: public health, market regulation and the European Semester [10, 11] This situation has led to primarily ‘uninvited’ Europeanisation of health systems often resisted by domestic stakeholders [12]. Analysis of the implementation of the patients’ rights and cross border care directive indicates the variable effects on Member State health systems [18,19,20,21,22,23]. These developments point to an increasingly important role for the EU in influencing health systems. The future role of the EU regarding health systems appears unclear at this point, with either role expansion or retrenchment being possible outcomes
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