Summary: EU economic governance, between the commodification of health and the well-being economy

EUhealthgov |

EUHealthGov held its tenth webinar on 28 February 2024. We were delighted to welcome Roland Erne (University College Dublin) and Vania Putatti (EuroHealthNet), to discuss health in the EU’s economic governance framework.

The EU’s economic governance framework is both a crucial and an under-examined facet of EU health policy. The framework was created in the aftermath of the financial crisis, economic recession and resulting social crisis that began in the late 2000s. It is designed to prevent future crises by imposing strict debt and deficit limits upon national governments, with the goal of ensuring economic stability. The European Semester, its core implementing instrument, is an annual cycle of coordination: the Commission publishes a statement of priorities and objectives (the Annual Sustainable Growth Survey), national governments draw up plans to respond to these priorities (the National Reform Programmes / Stability and Convergence Programmes), and the EU then adopts recommendations to each government on the basis of these plans (the Country Specific Recommendations). Whilst not intended as a tool of health policy, these recommendations have consistently addressed health policy issues, including the organisation, delivery and financing of healthcare, which are reserved as national competences in the founding treaties.

Despite the significance of the economic governance framework for health governance, relatively little is known about its implications. The webinar brought together insights from two projects that seek to address this gap.

Roland Erne presented the finding of their European Research Council project, conducted with Sabina Stan, on the European Commission and the Council of finance ministers’ economic governance prescriptions on healthcare for Germany, Ireland, Italy, and Romania from 2009 to 2019. Roland described how the EU’s market integration had shifted, via the new economic governance framework, from a horizontal to a vertical integration, imposing top-down influence on healthcare. He explained that the recommendations issued to member states vary in their ‘hardness’ or ‘softness’ depending upon their legal basis, as well as the financial situation of the member state to which they are directed. Turning to the analysis conducted in their recent paper, Roland presented a framework of commodifying and decommodifiying recommendations, and explained how references to, for instance, increasing access to care, or containing hospital expenditure, were used to identify (de)commodifying prescriptions. He then showed a series of diagrams illustrating the variance in prescriptions across time, and member states. The core finding of the work is a common commodifying agenda, but one which is pursued more strongly in member states which are ‘lagging behind’ in their healthcare commodification.

Vania Putatti presented the latest report by EuroHealthNet, a Brussels-based health NGO which has been analysing the European Semester’s health implications since it was launched in 2011. He first introduced the concept of a wellbeing economy, which seeks to challenge the dominance of GDP as a measure of growth, by accounting for wider social, environmental and health trends. Since the Semester is at the core of the EU’s economic policy and is used to pursue the European Green Deal, the UN Sustainable Development Goals, and a variety of other EU priorities, EuroHealthNet’s work has focused on how it might be repurposed and reformed to better serve people and planet. Vania explained the narrative that currently pervades the Commission’s descriptions of the Semester, which refers heavily to inclusive growth, sustainability, social and economic convergence, and the just transition. There is, he argued, space within this narrative to see the Semester used in support of a wellbeing economy, though the need to follow narrative with action was clearly noted.

Both Roland and Vania spoke to the political implications of their research and made a series of recommendations, including the adoption of a directive on minimum standards for access to healthcare, a revision of the Stability and Growth Pact to ensure high quality public services, the appointment of a Commission Vice President for a Wellbeing Economy, and the creation of an EU Wellbeing Strategy. In this sense, the upcoming elections, and new term of the European Commission, will be key in determining the future trajectory of the economic governance framework.

A recording of the webinar will be available shortly via the EUHealthGov website.