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Cross-Border Healthcare in Europe: Does Network Governance Bridge Healthcare System Differences?

European Union
Governance
Public Administration
Public Policy
Regulation
Policy Implementation
Survey Research
Dorte Sindbjerg Martinsen
University of Copenhagen
Dorte Sindbjerg Martinsen
University of Copenhagen
Ellen Mastenbroek
Radboud Universiteit Nijmegen
Reini Schrama
University of Copenhagen

Abstract

Increasing interdependencies in Europe require European Union (EU) member states to coordinate and regulate the take-up of healthcare across borders. However, healthcare remains one of the core policy domains of nation states. This results in a considerable variation in the way healthcare is organized domestically and a general reluctance to delegate national responsibility to the supranational level. To deal with the complexity stemming from the gap in the governance system to combine supranational legislation with national implementation, the cross-border healthcare expert group (CBHC) is established. In this network, national healthcare authorities interact in a more horizontal manner aims to increase the ability of patients to take-up planned cross-border healthcare in the EU. It is an empirical question whether the exchange of information, advise and experiences can overcome policy complexities related to the national differences entrenched in national healthcare systems. To test what drives network interactions concerning cross-border healthcare we use social network analysis on our own collected survey data on interaction modes within the CBHC network. We build a typology of healthcare systems in EU28 + Norway and Iceland, based on indicators on the financing, provision and governance of healthcare. Using cluster analysis we find five distinct healthcare types. Moreover, our social network analysis with Exponential Random Graph Models demonstrates that interactions replicate exiting policy complexity and occur predominantly among those that are institutionally similar.