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Balancing economic freedom against social policy principles: EC competition law and national health systems


  • Mossialos, Elias
  • Lear, Julia


EU Health policy exemplifies the philosophical tension between EC economic freedoms and social policy. EC competition law, like other internal market rules, could restrict national health policy options despite the subsidiarity principle. In particular, European health system reforms that incorporate elements of market competition may trigger the application of competition rules if non-economic gains in consumer welfare are not adequately accounted for. This article defines the policy and legal parameters of the debate between competition law and health policy. Using a sample of cases it analyses how the ECJ, national courts, and National Competition Authorities have applied competition laws to the health services sector in different circumstances and in different ways. It concludes by considering the implications of the convergence of recent trends in competition law enforcement and health system market reforms.

Suggested Citation

  • Mossialos, Elias & Lear, Julia, 2012. "Balancing economic freedom against social policy principles: EC competition law and national health systems," Health Policy, Elsevier, vol. 106(2), pages 127-137.
  • Handle: RePEc:eee:hepoli:v:106:y:2012:i:2:p:127-137 DOI: 10.1016/j.healthpol.2012.03.008

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    References listed on IDEAS

    1. Scharpf, Fritz W., 2002. "The European Social Model: Coping with the challenges of diversity," MPIfG Working Paper 02/8, Max Planck Institute for the Study of Societies.
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    4. Varkevisser, Marco & Capps, Cory S. & Schut, Frederik T., 2008. "Defining hospital markets for antitrust enforcement: new approaches and their applicability to The Netherlands," Health Economics, Policy and Law, Cambridge University Press, vol. 3(01), pages 7-29, January.
    5. Tsoukalis, Loukas, 2005. "What Kind of Europe?," OUP Catalogue, Oxford University Press, number 9780199279487, June.
    6. Sauter, W. & Canoy, M.F.M., 2009. "Hospital mergers and the public interest : Recent developments in the Netherlands," Discussion Paper 2009/35, Tilburg University, Tilburg Law and Economic Center.
    7. Sauter, W., 2008. "Services of general economic interest and universal service in EU law," Discussion Paper 2008-017, Tilburg University, Tilburg Law and Economic Center.
    8. Ferrera, Maurizio, 2005. "The Boundaries of Welfare: European Integration and the New Spatial Politics of Social Protection," OUP Catalogue, Oxford University Press, number 9780199284672, June.
    9. Fidler, Armin H. & Haslinger, Reinhard R. & Hofmarcher, Maria M. & Jesse, Maris & Palu, Toomas, 2007. "Incorporation of public hospitals: A "Silver Bullet" against overcapacity, managerial bottlenecks and resource constraints?: Case studies from Austria and Estonia," Health Policy, Elsevier, vol. 81(2-3), pages 328-338, May.
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    Cited by:

    1. Loozen, Edith M.H., 2015. "Public healthcare interests require strict competition enforcement," Health Policy, Elsevier, vol. 119(7), pages 882-888.


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