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BMC Public Health
Published in: BMC Public Health 1/2016

Open Access 01-12-2016 | Research article

Europeanisation of health systems: a qualitative study of domestic actors in a small state

Authors: Natasha Azzopardi-Muscat, Kristine Sorensen, Christoph Aluttis, Roderick Pace, Helmut Brand

Published in: BMC Public Health | Issue 1/2016

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Abstract

Background

Health systems are not considered to be significantly influenced by European Union (EU) policies given the subsidiarity principle. Yet, recent developments including the patients’ rights and cross-border directive (2011/24 EU), as well as measures taken following the financial crisis, appear to be increasing the EU’s influence on health systems. The aim of this study is to explore how health system Europeanisation is perceived by domestic stakeholders within a small state.

Methods

A qualitative study was conducted in the Maltese health system using 33 semi-structured interviews. Inductive analysis was carried out with codes and themes being generated from the data.

Results

EU membership brought significant public health reforms, transformation in the regulation of medicines and development of specialised training for doctors. Health services financing and delivery were primarily unaffected. Stakeholders positively perceived improvements to the policy-making process, networking opportunities and capacity building as important benefits. However, the administrative burden and the EU’s tendency to adopt a ‘one size fits all’ approach posed considerable challenges. The lack of power and visibility for health policy at the EU level is a major disappointment. A strong desire exists for the EU to exercise a more effective role in ensuring access to affordable medicines and preventing non-communicable diseases. However, the EU’s interference with core health system values is strongly resisted.

Conclusions

Overall domestic stakeholders have a positive outlook regarding their health system Europeanisation experience. Whilst welcoming further policy developments at the EU level, they believe that improved consideration must be given to the specificities of small health systems.
Footnotes
1
The European Semester is an EU-level policy co-ordination tool that contributes towards the broader EU aims of strengthening economic governance and greater policy co-ordination. This tool provides a more integrated surveillance framework for the implementation of fiscal policies under the Stability and Growth Pact, and the implementation of structural reforms through national reform programmes. The Commission publishes Country-Specific Recommendations for each Member State on the basis of a thorough assessment of every Member State’s plans for sound public finances and policy measures to increase growth and jobs. For further information, the reader is referred to http://​ec.​europa.​eu/​europe2020/​making-it-happen/​index_​en.​htm [accessed on 6 September 2015]
 
2
For a comprehensive yet simple introduction to Europeanisation theories, the reader is referred to Harwood Mark, Chapter 3 Europeanisation in Malta in the European Union Ashgate Publishing 2014.
 
3
English is an official language in the Republic of Malta.
 
4
The main health strategies published during the period following accession are listed in Chapter 6 of the Health Care Systems in Transition Report for Malta, which is available at http://​www.​euro.​who.​int/​en/​about-us/​partners/​observatory/​publications/​health-system-reviews-hits/​full-list-of-country-hits/​malta-hit-2014 [accessed on 09/10/15].
 
5
The European Commission issued guidance on a number of conditionalities that need to be fulfilled for access to the European Structural and Investment Funds 2014–2020. In the area of health, the existence of a strategic plan for the health system is one such criterion. Further information is available at http://​ec.​europa.​eu/​regional_​policy/​index.​cfm/​en/​information/​legislation/​guidance/​ [accessed on 6 September 2015].
 
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Metadata
Title
Europeanisation of health systems: a qualitative study of domestic actors in a small state
Authors
Natasha Azzopardi-Muscat
Kristine Sorensen
Christoph Aluttis
Roderick Pace
Helmut Brand
Publication date
01-12-2016
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2016
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/s12889-016-2909-0

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