Healthcare Regulation in the European Union – University of Copenhagen

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Healthcare Regulation in the European Union; A Policy-Cycle Study of Complex Decision Making and Implementation

The research project examines the policy-cycle establishing cross-border healthcare in the European Union. The project combines a focus on the inter-institutional dynamics of EU policy-making with comparative research on implementation processes in selected member states. The project aims to contribute to our empirical and theoretical knowledge on the complex interplay between judicial and political policy-making and the impact of national institutions in subsequent processes of Europeanisation.

The Project Team

Professor (MSO)  Dorte Sindbjerg Martinsen (Sapere Aude PI), Political Science, University of Copenhagen

Professor Karsten Vrangbæk, Political Science, University of Copenhagen  

Assistant professor Hans Vollaard, Leiden University 

PhD candidate Nikolay Vasev, Political Science, University of Copenhagen

Research assistant Jessica Maria Sampson Thierry. E-mail:   


PhD candidate Ayca Uygur, Political Science, University of Copenhagen

Associate professor, Filip Křepelka, Faculty of Law, Masaryk University

Project Description

EU regulation is becoming increasingly important, even in the area of health care which was previously regarded as the sole responsibility of the member states. For more than a decade, case-law interpretations by the European Court of Justice (ECJ) has gradually questioned the national demarcations and organisational boundaries within the member states and judicial activism has brought the healthcare sector far into the organizing principles of the internal market. A political response has long been asked for. This supranational process of re-organization through judicial policy-making has been examined to some extent by European and Danish scholars (Greer 2006; Hervey 2008; Mossialos et al. 2002; Permanand & Mossialos 2005; Martinsen & Vrangbæk 2008; Martinsen 2009; Vollaard 2009). However, we have little scholarly knowledge about the parallel and subsequent political policy-making process and no systematic comparative studies have been conducted on healthcare implementation in member states. This project aims to provide such knowledge, addressing the following research question: 

How may inter-institutional dynamics drive or hinder political regulation of cross-border healthcare in the EU, and how may different national healthcare institutions and their legacies explain variation in national implementation strategies for EU cross border care?

The Three Parts of the Project

The project is divided into three parts:

Part 1 examines the policy-making process behind the now adopted Directive on Patients rights in cross-border healthcare 2011/24/EU, which grants patients considerable rights to be treated in another member state. It examines the inter-institutional dynamics in the policy-process unfolding between the European Commission, the European Parliament and the Council of Ministers. In addition, it looks into the role played by the European Court of Justice, when negotiating 'in the shadow of the law'.

Part 2 examines the subsequent implementation process of the patient rights directive in five selected member states; Sweden, Denmark, the Netherlands, Spain and Poland.

Part 3 consists of a ph.d. project which will examine implementation in two different member states; Austria and Bulgaria. Both part 2 and 3 of the project address a considerable lack in our empirical and theoretical knowledge, namely EU induced processes of change in Central and South-Eastern Europe. In addition, the Ph.d. candidate will be encouraged to pay special attention to the role played by interest organisations for healthcare professionals, patients, insurance companies and private health care providers in the national implementation. 

The three parts are highly intertwined by examining different parts of the same policy cycle, part 1 constituting the independent variable for part 2 and 3.

  Research Design

Independent variable

Intermediate variable

Dependent variable

Developments in EU regulation of cross border care (ECJ and Directive) (examined in part 1) National institutional legacies and configuration of health systems Variation in national implementation strategies for cross border care