Princeton University Library Catalog
- Azarrafiy, Ryan [Browse]
- Senior thesis
- Meunier, Sophie [Browse]
- Woodrow Wilson School of Public and International Affairs [Browse]
- Class year:
- 86 pages
- Summary note:
- Health policy has been gradually integrated at the European level since
Member States of the European Union (EU) started harmonizing their
regulations and building a single market with freedom of movement for goods,
people, and services. In the 1992 Maastricht Treaty, the European Union
formally gained competence to protect public health. In the 1998 Kohll and
Decker cases, the European Court of Justice ruled that the health sector falls
under the single European market, enabling patient mobility and reimbursement
rights across borders. The complex field of health policy, however, remains less
integrated than many other policy areas in the EU as national governments
maintain legal autonomy over the organization and delivery of health care. What
factors have driven the gradual integration of health policy in the EU?
This thesis explores the determinants of health policy harmonization in the
EU by developing hypotheses based on two theories advanced by political science
scholars of European integration to explain the factors that have driven the
harmonization of policy between the Member States of the European Union. One
theory, neo-functionalism, posits that policy harmonization occurs insidiously at
the European level as a result of spillovers and is then forced upon Member
States. Another theory, liberal intergovernmentalism, argues that EU policy
progresses at the sole discretion of Member States who agree on a course of
action based mostly on their national economic preferences.
This thesis utilizes a qualitative, case-study design to shed light on the
factors that have driven health policy harmonization in Europe. The Member
States of Austria and Hungary were selected due to their shared history in the
Austro-Hungarian Empire, geographic proximity, and cultural similarities.
Existing literature, a history of national health reforms, and European-level
activities were investigated in detail to understand whether neo-functionalism or
liberal intergovernmentalism explains health policy change in the respective
nations. With neo-functionalism, several conditions were utilized – such as
whether or not policy change stemmed from a different social sector – to
determine the type of spillover effect that best explains national legislation.
The cases of Austria and Hungary demonstrate that health policy
harmonization in the European Union is a neo-functional phenomenon.
Furthermore, this thesis proposes a more integrated, neo-functional model for
explaining the harmonization of national laws with EU policy. The cases showed
that the type of spillover effect depends largely on the specific aspect of health
care at play. The Commission, ECJ, and supranational agencies demonstrate
functional and cultivated spillover effects in workers’ health, e-Health, patient
mobility, and pharmaceutical regulations among others. Social and political
spillover offer an explanation in other sectors, such as population health. Lastly,
this thesis also found that the pre-accession stage enables unique, neo-functional
pressures for health harmonization prior to official EU membership.