Inside the black box: The EU's economic surveillance of national healthcare systems

In the context of macro-economic surveillance, the European Union(EU) increasingly addresses national health system reform. Member States receiving financial assistance are required to implement detailed reforms stipulated in 'Memorandums of Understanding' (MoUs). But the health systems in other (non-MoU) countries are also scrutinised in the context of the 'European Semester': through this annual policy cycle, the EU has continuously strengthened the tools it uses to enforce compliance. This article aims to open the black box of the EU's economic surveillance of national healthcare systems by outlining the complex policy architecture of the EU's newly acquired role in this area. The story of how health has emerged on the European agenda illustrates how the Eurozone crisis created a policy 'window of opportunity' to push through fiscal surveillance of health systems as part of the solution to the crisis. The cognitive frameworks put forward by certain elites added up to the primacy of an economic perspective over health objectives. Finally, our analysis of the role of the actors involved in the elaboration of EU guidance in the field of health points to the dominance of 'economic' actors and relative absence of 'health' actors, in spite of increased attempts by the latter to gain influence.