The Clash Between Market and Welfare State Models: Europeanization of Nordic Health Systems

The principle of universal coverage combined with public responsibility for regulating, financing and providing health sevices is at the core of the Nordic welfare state model. Recently, elements of this model has been challenged by the EU – Denmark, Sweden and Finland through their membership of the European Union (EU); Norway as part of the Agreement on the European Economic Area (EEA). EU does not have strong competencies in health policy. Still, the EU influences national health systems in a number of areas. Much of this influence is related to the EU’s regulation of the internal market. EUs market rules and principles concerning free movement of goods, persons and services have “spilled over” to the health area and affected national health systems in ways that were not originally foreseen nor anticipated by the member states. This is most evident by the implementation of the EU’s Patients’ Rights Directive. Based on the “goodness of fit hypothesis,” which says that a low goodness of fit between EU polices and national policies is assumed to create problems for domestic implementation, this chapter studies the Europeanization of Nordic health systems. The goodness of institutional fit between EU market rules and the traditional Nordic health systems is basically low, c.f. the “clash” between the EU market model and the Nordic welfare model. However, Nordic health systems have in some areas moved towards the market model. The chapter shows that part of this move is related to exposure to processes of Europeanization, i.e., adaptation to the EU’s rules on patients’ rights and cross-border care. In Norway, Sweden and Finland this adaptation have been facilitated by a relative high political-ideological fit at the time of implementation and transposition of EU rules. In Denmark, this fit has been lower and the adaption to the EU has been more limited and reluctant.