Search

Research has paid little attention to date on how European Union law and regulation affect both the public-private mix in healthcare and the organization of private health insurance as an industry. Filling this gap, this collective book provides insights on the political economy of EU insurance regulation, its impact on private health insurers and on its interactions with domestic healthcare policy-making in four countries. Assembling original contributions drafted by a multidisciplinary team, Private Health Insurance and the European Union offers a thorough examination of a largely unrecognized source of EU influence in healthcare – and sheds a new light on the role played by private actors in social policy.

Research has paid little attention to date on how the European Union (EU) affects private (usually voluntary) health insurance at domestic level and more broadly, the political economy of the public-private mix in healthcare. Our argument in this Introduction is that EU law and regulation is, essentially, likely to do so through the provisions applicable to the insurance sector as a whole. We then explain why it could potentially be a vehicle for transformative changes of private health insurers, and why, by extension, it could interact with the prior effects of domestic policy choices in healthcare. Ultimately, such interactions could also help change the nature and scope of health coverage. On the basis of these statements, we develop an analytical approach to elucidate, characterize and prove this influence. We then outline the research design and case selection processes and discuss the various methods applied in the nine contributions to this book. After a short summary of their respective findings, we reflect in a concluding section on how they echo wider debates in the literature on the role of private actors in contemporary Welfare States and on EU influence in healthcare.

International audience; In Belgium, the “public” side of health coverage is delegated and organized around non-profit private health insurers, namely mutual benefit societies, and as such, it is excluded from the perimeter of EU insurance law and regulation. Over the last two decades, and as a result of various governmental attempts to reduce health expenditure, mutual benefit societies nevertheless developed and managed on their own a variety of complementary coverage. This situation was challenged during the 2000s by for-profit insurance companies seeking to penetrate the market. In this context, they used both Insurance and Solvency II directives in their search for supranational support to challenge the position of mutual benefit societies. In turn, the latter responded by working politically to secure their position at the domestic level. As a result of these political struggles, a reform adopted in 2010 reinforced several features of the Belgian public-private mix by safeguarding the position of mutual benefit societies for complementary coverage. But this same reform also opened the supplementary side of health coverage to competition and aligned it with EU provisions, thus marketizing a share of the public-private mix in Belgium—with recent figures suggesting that this new pillar is now expanding.

International audience; The present chapter seeks to analyze the impact of EU law on private health insurance at national level. Does EU law have a vertical impact leading to a rather standardized situation or can we observe a more contrasted landscape? The chapter proposes a two-sided approach: on the one hand, a study of EU internal market law that frames and aims to regulate the health insurance market; on the other hand, a comparative overview of various national arrangements as far as health insurance marketization is concerned. Two main results are brought out. First, though EU law appears to be a "matrix" for private health insurance activity, it is actually rather flexible so that there is latitude for national regulation of the PHI market. This generates some uncertainty. Second, there are various forms of arrangements at national level relating to health coverage, and this is why the impact of EU law is differentiated.

International audience; There is a growing body of studies emphasising the multi-pillar configuration of protection against social risk in Europe, particularly in pension reform. In this chapter, we try to expand on this literature to find applicability beyond the sole case of pensions by looking at the case of occupational health insurance in France. In order to do so, we present a restatement of the pillar/provision perspective in order to apply it to a broader range of cases. We argue it is a powerful analytical tool provided it is complemented with a (non-exhaustive) list of perspectives widely used in studies on social policy and does not blunder into the pitfall of functionalism. The chapter focuses on crossing the pillar perspective with a finance and also a regime perspective. Following the seminal intuition of R. Titmuss, an important result yielded is that the overall structure of resources distribution of the whole welfare system can become highly anti-redistributive once occupational schemes and fiscal incentives are included in the analysis.

International audience

International audience

International audience; The European Union appears to be promoting at the same time both cross-national mobility of workers and an increased role for occupational pensions. There is, however, a potential tension between these two objectives because workers risk losing (some of) their pension rights under an occupational scheme as a consequence of their mobility. After long negotiations, the EU has addressed this issue through a minimum standards Directive. Shortly before the adoption of this Directive, the Court of Justice also delivered an important decision in the same field, in the case of Casteels v British Airways. By analysing the resulting legal framework for safeguarding pension rights under occupational schemes in the context of workers’ mobility, we argue that the application of the case law developed by the Court of Justice in the field of free movement of workers has the potential to offer superior protection compared to the Directive. We also highlight the fact that the present legal framework seems to afford a much fuller protection to the intracompany cross-national mobility of workers employed by multinational companies, while also seemingly favouring mobility for highly specialised workers.

International audience

The numbers are dizzying. The impacts of healthcare-related fraud and corruption are astounding. Some estimate that 56 billion euros are lost to fraud annually in Europe – that’s to say almost 80 million euros lost per day, more than 5% all EU national health budgets put together (Gee and alii, 2010.)

Historically, private health insurance (PHI) in France (which covers the complementary share of health expenditures) has been dominated by non-profit entities, namely mutual benefit societies. The sector has experienced a manifold marketization process over the recent years, partly due to the application of EU law and regulation. Yet this chapter argues that it has been decisively reinforced and sometimes shaped by a series of policies adopted at the national level. Indeed, over the last 20 years, successive French governments have tried to increase health coverage without increasing the share already covered by the public purse. This strategy ostensibly involved private health insurers in achieving several governmental objectives, yet the prior effects of Europeanization on these entities were poorly acknowledged by policymakers. As such, the many consequences associated with the rise of a “European-driven” market now increasingly conflict with a “State-driven” market. This, in turn, has strong implications for the scope and the nature of health coverage.