Market Competition in Health Care: The EU’s Parallel Struggle

Last week, I took a break from U.S. health reform and attended a fascinating conference on Health Care and EU Law at Radboud University in the Netherlands.  It gave me the chance to step back and revisit a struggle common to most health care systems — the appropriate role for market competition.  Without drawing too many parallels here, the view from 30,000 feet confirms that like the United States, European health care systems (varied as they are) must decide the extent to which health care is an economic, commercial product versus a non-economic, public good.

In Europe, this tension is generated by the European Union’s internal common market of 27 member states.  European law — enunciated through treaties, directives, regulations, and decisions by the European Court of Justice — prohibits states from restricting the free movement of goods, persons, and services within the EU, and bans anti-competitive or protectionist arrangements.

But is health care a commercial product subject to these market rules?  Or can member states control their health care systems without worrying whether it restricts free movement or is anti-competitive?  Although EU law says that states shall retain responsibility for managing services of general interest like health care and social security, case law has bounded this authority in several high-profile free movement and competition cases.  For example, a series of court opinions has held that member states have limited authority to prevent their residents from traveling to other member states for health care, or even to require prior authorization before reimbursing for that care back in the home state. Read more