Exploring Europeanisation processes in healthcare: the use of European instruments in French, Austrian, and Irish eHealth policies

Exploring the effects of European integration on domestic health politics and policies has always been a challenge for researchers. Indeed, healthcare is a ‘least likely’ case for Europeanisation (Martinsen 2012), and research on this subject tends to present health as an area in which EU direct influence is particularly limited (even when compared to other social policies areas, such as employment for instance). One of the main difficulties in evaluating how European integration affects domestic health politics and policies is linked to the fact that EU instruments in this area are particularly ‘soft’, and consist merely in non-binding guidelines emerging from domestic actors’ repeated interactions at the European level. Often, studies in this area focus specifically on these interactions, showing that socialisation, mimicry, persuasion and exchange of ideas lead to an increasing penetration of the European space into the domestic space of healthcare policy-making (Sabel and Zeitlin 2008; Borrás and Jacobsson 2004). In order to facilitate the observation and the comparison of Europeanisation processes in healthcare, this article combines an ‘usage’ approach (which focuses on the use of European instruments by domestic actors in their policy work, see: Jacquot and Woll 2004; Graziano et al. 2013) with a revised version of the Multiple Streams Framework initially developed by John W. Kingdon (1984, 2002). This new conceptualisation is applied to the analysis of eHealth policies in three similar cases: France, Austria, and Ireland. Ehealth refers to the introduction of Information and Communication Technologies (ICT) in health and is now a significant component of healthcare policies in many countries. The development of Electronic Health Records (EHRs) is often considered as a major building block of eHealth policies and has long been promoted by the European Commission through soft law instruments (Communications, Recommendations, guidelines…). Recently, because of the Covid-19 crisis, eHealth has gained even more attention, especially regarding telemedicine devices and contact tracing applications. This article explores the various types of EU usage at work in the making of eHealth policies, and describes how these uses of European instruments operate in the political, problem, or solution ‘streams’ of domestic healthcare policy-making. This new conceptualisation of Europeanisation processes allows for the spotting of specific differences between the three cases under study, enabling for the testing of various well-entrenched hypotheses (such as the ‘misfit’ hypothesis -Börzel and Risse 2003 - or the relationship of a country to the EU). More importantly, this research shows that this area is far from being exempt of EU influence, despite the fact that health remains under the jurisdiction of member states.