Health and the European elections: Making a case for EU Competence in Health

by Elliot Tricot O'Farrell

The confirmation of Ursula von der Leyen as the first woman to hold the office of President of the European Commission represents a major step forward for the European Union.

As the EU works towards defining its priorities for the next five years, we look into the future of another hot topic and consider why an EU competence on health-related matters could add value to European citizens.

Stakeholders advocating for EU action in health-related matters will have a thorough understanding of how contentious it is to advocate for EU competence in this field. Presently belonging to Member States, the competence is placed highly on the national agenda and national policymakers are reluctant to transfer it to Europe. However, with European legislation being passed on Cross-Border Healthcare, Clinical Trials and attempts made towards a joint-approach to Health Technology Assessments, we can wonder how so many legislative acts are being drafted on health-related matters in the EU?

Surging activity in healthcare at the European level

Several factors influence the adoption of health-related policies.

The EU’s inherent structure means that political spill-over often leads to the implementation of EU legislation in areas such as the internal market and competition law with repercussions in health. Moreover, the EU’s determination to lay the foundations of an “ever-closer union” among the peoples of Europe also has practical consequences on EU competence in healthcare. EU institutions have been progressively removing barriers to EU-wide cooperation through a process of negative integration. These structural factors have led to EU healthcare law becoming a mosaic of provisions with constitutionally different origins.

Political influences can also impact EU legislation in healthcare as Members of the European Parliament often advocate for more work to be done on health issues. Policymakers – always looking to the next elections – will favour working on files which resonate well with their voters. A Eurobarometer survey recently established that more than 70% of Europeans wanted more action in health, this upward trend would encourage policymakers to work on health-related files. This trend was famously confirmed by MEP Manfred Weber, the EPP’s former Crown Prince, who espoused the cause of cancer patients during his political campaign for the Commission Presidency by promoting his EU Masterplan against Cancer.

Making a case for the EU?

In truth, the legal competence of the EU in healthcare has become increasingly ambiguous as Members States progressively recognize the necessity of cross-border resolutions to resolve health-related issues. The realities of modern society mean that health-related problems cannot be addressed by a single Member State.

Leading EU Member States, such as Germany, are often advocating for a national approach to health matters. This is confirmed within the Treaty on the Functioning of the European (TFEU) which outlines the subsidiary position of the EU in defining healthcare policies. The EU’s output on health legislation should, therefore, be minimal. However, as we have observed, this is not reflected in reality as the EU regularly works on files with an impact on the health of EU citizens. The discrepancy between Member States who want to “pump the brakes” and those advocating for more EU action in healthcare has led to a compromise in the TFEU. By stating that a “high level of human health protection shall be ensured” in the definition and implementation of all Union policies and activities, the TFEU has left the door open to European actors favouring increased involvement of the EU in healthcare.

Without delving into the reasons Member States believe they should retain the primary competence in healthcare, we should consider the potential added value of EU competence on health for Member States and European citizens. By the virtue of the EU’s resources, its societal role and the central position it occupies in European politics, giving the EU more competencies in health could make it a core policy area through which the EU positively influences the lives of European citizens. Despite the competency belonging the Member States, the EU has adopted landmark measures in health, such as Cross-Border Healthcare and the European Reference Networks (ERNs), which can improve the lives of European patients tremendously.

The EU has the potential of stifling growing healthcare costs by making healthcare systems more sustainable. As of today, costs are barely being covered across Europe. An ageing European population, the rise in chronic disease and the increasing cost of medical technologies are additional developments which have led the World Bank to estimate that public expenditure on healthcare in the EU could grow to 14% in 2030 and continue to grow beyond that date. The EU could help reduce the cost burden on national health systems by, for instance, harmonising processes and eliminating duplicate work across Member States.

The EU’s coordinating and centralising capacities are another major EU asset. Not only can it reduce costs by suppressing duplicate work across countries, but the EU can also act as a central point for health data. The EU already coordinates and incentivise research and innovation by funding for health projects. A harmonious system across Europe would be an additional benefit for the many stakeholders active in the field of health.

Through the EU, the optimisation of the delivery of healthcare to citizens and the promotion of high quality and efficient health care systems would be facilitated. The EU can help reduce inequalities from inequalities in access to doctors to access to innovative treatments. The implications of the EU being competent in healthcare would be hugely significant for healthcare professionals, for national regulatory structures and patients.

In our work, we have seen great advances in healthcare policies which demonstrate the value of an EU approach. The erosion of national competence in the field of health can be seen positively as it has led to the slow and gradual adoption of increasingly ambitious policies. Presently, the competence of Member States means that stakeholders advocating for the EU to launch health initiatives must frame the issue through areas in which the EU is competent. For instance, the Cross-Border Healthcare initiative finds its legal basis in the internal market. The arguments put forward by Member States who wish to conserve their primacy in healthcare are by no means unreasonable and should not be discarded. But the argument can be made that the added value of the EU outweighs the potential downsides. Whichever course the EU adopts, RPP Group will remain committed to identifying key EU opportunities to develop a healthcare competence that best serves patients and society.