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A judicialisation of healthcare policies in Denmark and Spain? The universalist healthcare model meets the European Union

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Comparative European Politics Aims and scope

Abstract

This article examines the impact of judicialisation on the right to cross-border healthcare in Denmark and Spain, that is, the national impact of legal integration as spurred by the Court of Justice of the European Union. We expect the national impact of judicialisation to be conditioned by the ex-post judicial, administrative and political responses, particularly the national courts’ activation of EU law. By using new data, a compilation of national court cases, quasi-judicial proceedings and research interviews with key respondents, we examine the process of judicialisation in the two member states. The findings demonstrate that the national courts hardly played a role in Denmark and that although the courts were more active in Spain, the rulings remained largely unobserved by the political and administrative elite and the courts were thus unable to push for change. The administrative and political responses were found to be quite similar in the two member states, adapting to EU-induced changes in a protectionist and defensive manner. We conclude that the two universalistic healthcare models have so far proved resistant to judicialisation and that the discrepancy between what emerges de jure at the supranational level and the de facto rights produced at the national level is still a wide one.

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Notes

  1. See in particular the following cases; C-120/95 Decker [1998] ECR I-01831; C-158/96 Kohll [1998] ECR I-01931; C-368/98 Vanbraekel [2001] ECR I–5363; C-157/99 Geraets-Smits and Peerbooms [2001] ECR I-05473; C-326/00 Ioannidis [2003] ECR I-1703; C-385/99 Müller-Fauré and Van Riet [2003] ECR I-04509; C-56/01 Inizan [2003] ECR I–12403; C-8/02 Leichtle [2004] ECR I-2641; C-372/04 Watts [2006] ECR I-4325; C–466/04 Acereda Herrera [2006] ECR I–5431; C-444/05 Stamatelaki, [2007], ECR I-3185; C-211/08 Commission v Spain [2010] ECR I-5267; C-512/08 Commission v France [2010] ECR I-8857; C-490/09 Commission v Luxembourg [2011] ECR I-249; C-255/09 Commission v Portuguese Republic [2011] ECR I-10547; C-173/09 Elchinov [2010] ECR I-8889.

  2. Directive 2011/24/EU on the application of patients’ rights in cross-border healthcare.

  3. For this turn in legal interpretations, see in particular C-512/08 Commission v France [2010] ECR I-8857.

  4. The search was done in national case law databases (Spain: www.poderjudicial.es/search/indexAN.jsp and Denmark: jura.karnovgroup.dk) compiling national courts’ ruling basing decisions on any of the CJEU cases on Patient Mobility specified in footnote 1 above. The data covers litigation from supreme and higher regional courts. Lower court cases are not exhaustively covered because they are underrepresented in these databases. Interviews with key-respondents, however, confirmed that lower courts were not active in enforcing EU cross-border healthcare law.

  5. Case U.2004.1126H.

  6. The compilation of cases has excluded the cases dealing with dental care.

  7. The policy reform entered into force by executive order, BEK no. 536 of 15 June 2000.

  8. Patients insured in Denmark must choose between Group 1 or Group 2 coverage. Care from the GP and specialists in Group 1 is free of charge; a specific GP is choosen who then refers for further treatment. Patients in Group 2 are not assigned a specific GP but enjoy access to any GP or specialist on request. However, only a part of the costs for treatment in Group 2 is reimbursed. Roughly 98 per cent of Danish residents are insured in Group 1.

  9. Internal unofficial departmental note from the Ministry of Interior and Health, 22 March 2004.

  10. Case before the National Social Appeals Board, 31 October 2003.

  11. Case before the National Social Appeals Board, 29 September 2006, SM S-2-06.

  12. The policy reform entered into force by executive order, BEK no. 1098 19 November 2008.

  13. A third case C-466/04 Acereda Herrera considered reimbursement of authorisation based on regulation 1408/71.

  14. C-145/03 Keller.

  15. C-211/08 Commission v Spain.

  16. The ‘Commission report on the operation of Directive 2011/24/EU on the application of patients’ rights in cross-border healthcare’ (COM, 2015, 421 final) places Denmark in top with 31 032 reimbursements of healthcare across border that do not require prior authorisation. However, the large majority of treatment in another member state concerned dental treatment. In a response to the Danish parliament, the Danish Healthcare Minster noted that for the three regions that were able to give detailed information on cross-border healthcare, 98 per cent of all applications concerned dental care amounting to 78 per cent of all costs reimbursed for healthcare in another member state as according to the PRD (see parliamentary question 752 of 24 April 2015. Also confirmed by the Danish contact point for cross-border healthcare through mail correspondence, 6 October 2015).

  17. Eurobarometer on Patients’ rights in cross-border healthcare in the EU: ec.europa.eu/public_opinion/archives/ebs/ebs_425_en.pdf.

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Acknowledgements

Financial support from the Danish Research Council project no. 10-079675/FSE is gratefully acknowledged.

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Correspondence to Dorte Sindbjerg Martinsen.

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Martinsen, D., Mayoral Díaz-Asensio, J. A judicialisation of healthcare policies in Denmark and Spain? The universalist healthcare model meets the European Union. Comp Eur Polit 15, 414–434 (2017). https://doi.org/10.1057/cep.2016.7

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