Europe is steadily moving toward a Health Union. Contrary to what the title suggests, this is not about unifying and standardizing all healthcare systems in the EU. However, such a pan-European healthcare concept is interesting to explore—so let’s do it!
According to Article 168 of the Treaty on the Functioning of the European Union, public health and healthcare policies are the responsibility of the member states. While they define and deliver medical and insurance services, the EU only acts as a supporting entity and cannot interfere nationally. This legal stipulation is why a unified healthcare system cannot be introduced.
However, the quality of healthcare varies from one member state to another. Safe and immediate access to healthcare can be restrictive. Improvements and digitization are proceeding at different speeds. According to the EU’s official “2030 Digital Decade: eHealth Indicator Study,” some countries are already highly advanced in e-health, while others are still in the early stages of adoption.
Wouldn’t it make more sense to establish a unified pan-European healthcare system?
A deeper dive into a unified, pan-European healthcare system
The concept of a single comprehensive border-crossing healthcare system would not only be a significant step toward the tighter integration of member states but also present a broad range of additional benefits:
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Free access to healthcare—everywhere: EU residents could access medical services with consistently high quality and lower bureaucratic barriers across all EU member states. This would particularly benefit people in economically weak countries, tourists, and people regularly crossing borders.
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Uniform medical standards: This healthcare system would harmonize medical care and quality assurance and facilitate stronger collaboration between member states regarding research, development, and resilience.
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Seamless use and optimization of resources: Staff shortages, the lack of expertise, and medical devices could be efficiently compensated across Europe.
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Last but not least, digitization and data exchange: An interoperable health record system would support the EU-wide exchange of patient data, improving the coordination of medical treatment. Additionally, unifying digital administrative processes like authentication and signatures would lower bureaucratic overhead, freeing time for medical personnel to invest in patient care.
So, why wouldn’t it work out?
Several factors make this concept impossible to implement if not appropriately addressed:
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Loss of sovereignty: A central EU authority would co-decide on health budgets, reimbursements, vaccination strategies, and health insurance models, among other things. This means that member states would have to relinquish their sovereignty in this area, which could be met with resistance. Whether all member states would be willing to enter the necessary cooperation and reform agreements is questionable.
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Different funding and insurance models: Harmonizing and streamlining the different insurance models, contributions, and reimbursement structures prevailing in the 27 member states would be highly complex and financially challenging. In addition, the EU Commission would have to establish a solidarity package to support economically weak countries, potentially funded by taxation.
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Health tourism: The prospect of cheaper and better offers and services or shorter waiting times in other member states could increase the risk of health tourism. This inevitably increases the burden on the respective systems.
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Varying working and educational conditions, language barriers, and cultural differences: Qualification levels, working hours, and wages for medical professionals differ. The “brain drain” caused by a common labor market could exacerbate the staff shortage. At the same time, international qualifications are recognized to a limited extent, making it necessary to harmonize education, training, and requirements. Furthermore, language barriers would hamper communication between doctors and patients, and cultural expectations could cloud the acceptance of a unified healthcare system.
EU Health Union: Still in its infancy, but an important step toward more digital and accessible healthcare
Even if the law prevents the Commission from establishing a unified healthcare system across the EU, this does not mean it remains inactive. It mainly complements the political strategies and measures member states took to support and strengthen health in the EU, boost protection, prevention, preparedness, and response against human health hazards, improve access to pharmaceuticals, and support and expand digitization efforts in the medical field.
Proposed by Ursula von der Leyen in 2020, the Health Union – a healthcare framework – aims to strengthen disaster preparedness and make national healthcare systems more resilient and accessible, as the pandemic has shown how vulnerable these are. Since then, several legal proposals have been put forward and adopted to fine-tune the overall healthcare strategy and outcomes:
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Combatting transnational health threats: This includes the reinforcement of both the European Centre for Disease Prevention and Control (ECDC) and the European Medicines Agency (EMA), as well as the launch of the European Health Emergency Preparedness and Response Authority (HERA) in 2021. The latter focuses on improving EU health security coordination before and during (health) crises.
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Addressing widespread illnesses and medical conditions: The European Beating Cancer plan aims to facilitate cancer prevention and early detection. In addition, the EU supports the development of measures to counter antimicrobial resistance and the education about and access to mental health resources.
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Reforming the EU pharmaceutical legislation: According to the EU, all patients should have the same timely access to medicines. Thus, the Commission aims to modernize the pharmaceutical sector and make medication more accessible and affordable. The most recent development involves the proposal of the Critical Medicines Act in March this year.
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Digitization and Creation of European Health Data Space: One of the Health Union's main aims is to create a European Health Data Space. The initial purpose is to connect national infrastructures across Europe and thus create a pan-European infrastructure that enables consistent, secure, and efficient cross-border access, use, and exchange of health data, for both healthcare and research.
In addition, the EU is currently working on implementing cross-border e-health services. Most member states already offer e-prescriptions, allowing EU citizens to submit their prescriptions and receive medication anywhere in the EU. Patient summaries—a shorter version of electronic health records—are gradually being submitted, delivering all relevant information on foreign patients in the doctors’ native language. By 2030, all EU citizens are supposed to have access to a comprehensive electronic health record.
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