| The main interest in this study is the question of whether the European Union (EU) member states are still capable to ensure equitable access to health care or whether the integration process is a mechanism that leads to social exclusion. I am asking what the effect of the integration process has been and is likely to be in the near future in terms of health care protection. This general question consists of two sets of specific ones: First, to what degree does European integration lead to convergence of the individual states' health care systems, what is the character of such a convergence, and how is it being developed? Second, what is it about the decision mechanisms of the European health care systems---that is the day to day decisions about the production and distribution of health care---that on the one hand sustains their differences and on the other hand present us to a certain degree with assurances that social cohesion remains high on the agenda of policymakers?; The main argument of this study is that whereas health care financing and delivery is to date mostly absent from the European integration agenda, this is not the whole story. Through spillover from other policy areas, health policies are being influenced from the top and are bound to continue to do so. Three case studies (France, Greece and the Netherlands), remind us of the different balances of influence among key players and the different decision making mechanisms and explain why these systems will for the foreseeable future remain the responsibility of the member states. Notwithstanding these differences, however, the prominent place of the idea of social cohesion at both the central and the state level all but assures us that social solidarity will remain a primary goal in any reform effort of European health care. |
