When Europe meets Bismarck

What happens when the European Union sets new rules for the provision of
cross-border healthcare services that once were conceived for the population
living on the national territory ?

This books presents how new rules on the provision of cross-border healthcare
in the European Union have the potential of destabilizing national welfare
boundaries.

A book of political science that takes Austria, a prototypical Bismarckian
healthcare system, as an example, and aims at answering questions by looking
at how actors navigate between national institutional constraints and European
opportunities.

EXTRAIT

More than 30 years ago, the social security systems of OECD states were
diagnosed to be in crisis. This crisis heralded in the end of the “Golden Age”
of the national welfare state. The European OECD states, which were also part
of the European Community, all witnessed rising unemployment in the wake of
the oil crises, and as a result of economic openness to world markets and
rising competition of labor costs, Keynesian economic policies of deficit
spending became unavailable as an option to revive the economy. Not only did
external processes of globalization demand adaptations of the welfare states,
but also internal factors such as the rising age of populations and the change
of family patterns questioned whether European welfare states were still
capable of delivering for national populations, and how classical branches of
the welfare state such as unemployment insurance, pension systems and
healthcare systems should be adapted to meet these new challenges (Esping-
Andersen, 1996). Along with this crisis diagnosis of the welfare state in
general, healthcare systems have become the center of governments’ attention
since the 1980s, as spending on health policies has increased while the number
people contributing to the social security schemes has decreased due to rising
unemployment and slow economic growth. Insofar, healthcare mirrors the
challenges that welfare states face in general.