Integrating across policy sectors: how the wider public impacts on the drafting process of EU trans-border healthcare
| DOI | 10.1177/0020852316648225 |
| Date | 01 September 2018 |
| Published date | 01 September 2018 |
| Author | Miriam Hartlapp |
| Subject Matter | Articles |
International Review of
Administrative Sciences
2018, Vol. 84(3) 486–502
!The Author(s) 2016
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DOI: 10.1177/0020852316648225
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International
Review of
Administrative
Sciences
Article
Integrating across policy sectors:
how the wider public impacts on the
drafting process of EU trans-border
healthcare
Miriam Hartlapp
University of Leipzig, Germany
Abstract
Policy-making in the EU has been depicted as being starkly fragmented: initiatives are
drafted in separate Directorates-General of the EU Commission, discussed in specific
policy communities and decided upon in sectoral European Parliament Committees and
Council formations. At the same time, we see growing numbers of complex policy prob-
lems that require cross-sectorally integrated solutions. This article argues that there are
good grounds to expect policy-making in the EU Commission to favour fragmented solu-
tions, while diffuse public interests will tend to push f or integrated policies. However, it is
only under specific constellations that theEU Commission will respond to these interests.
The argument will be demonstrated using case study material on three policyinstruments
that address trans-border healthcare policy. While the Coordination of Social Security
Systems Regulation and the Services in the Internal Market Directive favour largely frag-
mented solutions, the Patient Mobility Directive takes a more integrated approach.
Points for practitioners
Today, complex policy problems often demand integrated policy solutions that cut across
organizational borders and areas of responsibility. At the same time, decision-making is
often easier if policy solutions remain fragmented.
Internal coordination is an important means for public administrations to reach
integrated instead of fragmented policy solutions.
Periods with high public attention are more likely to lead to more integrated policy
solutions, since policy-makers will seize internal coordination to anticipate the interests
of a wider public that is following the policy-making process. Evidence is provided from
drafting processes inside the EU Commission on trans-border healthcare acts.
Keywords
coordination, European Commission, health policy, public attention, responsiveness
Corresponding author:
Miriam Hartlapp, Institute for Political Science, Leipzig University, Beethovenstraße 15, 04107 Leipzig,
Germany.
Email: miriam.hartlapp@uni-leipzig.de
Introduction
In modern societies, a number of the most pressing policy problems – among them
demographic and climate change – are highly complex. A core feature of problem
complexity is functional indivisibility where solutions ‘straddle the borders of
organizations and ministerial areas of responsibility’ (Lægreid et al., 2015: 346).
Others, in turn, stress that disjointed and fragmented policy solutions result from
the policy-making process itself (e.g. Baumgartner and Jones, 1993: 235–251). In
particular, from the latter perspective, coordination is an important response to
complex problems.
1
In organizational studies, positive and negative coordination
procedures (Mayntz and Scharpf, 1975: 147–149), central coordination units
(Metcalfe, 1994: 284), joined-up government in the form of ‘interministerial or
interagency collaborative units’ (Christensen and Lægreid, 2007: 1061) as well as
hierarchy-type, market-type and network-type mechanisms (Verhoest et al., 2007:
325) have all been identified as means to coordinate policy-making processes.
Nonetheless, even when they are devised within the same coordination structures
at a given point in time, individual policy solutions to complex problems can differ
starkly in their level of fragmentation or integration.
In this article I focus on public attention as one of the contextual factors impact-
ing on the fragmentation–integration dimension of policy solutions. Looking at the
EU political system, I argue that the wider public has a greater interest in inte-
grated policy solutions than the EU Commission. Under closer public scrutiny, the
Commission is likely to become more responsive to this demand and will try to
produce more integrated policy output. This is evident in decisions on how to
organize its internal coordination process. In turn, absent public attention, the
EU Commission has little incentive to trade fragmented policy solutions that are
more favourable to decision-making against more integrated solutions. Thus, in this
article I link interest in organizational policy coordination to the growing research
focus on the responsiveness of EU institutions, and develop an argument about the
effect one factor (wider public attention) holds for policy output (integrated policy
solutions). In doing so, I emphazise (exogenous) strategic choice rather than
(endogenous) issue characteristics as explanations for negotiation outcomes.
Empirically, I analyse EU trans-border healthcare policy. Healthcare is a com-
plex problem that involves a plurality of interests: patients, healthcare professionals
and hospitals, insurance providers and insurance holders, and politicians and
bureaucrats. Interests cluster around a number of sectoral portfolios, which in
the EU system includes the Directorates-General for Economic and Financial
Affairs (DG ECFIN), Employment, Social Affairs and Equal Opportunities
(DG EMPL), Enterprise and Industry (DG ENTR), Internal Market and
Services (DG MARKT, today GROWTH), and Health and Consumers (DG
SANCO). In line with the well-established notion of bureaucratic fragmentation
in the EU Commission (e.g. Radaelli, 1999: 38–39; Trondal, 2012) these actors
often perceive problems differently. They have distinctive views, for example, on
how to judge the cost and quality of services, on the issue of rights to information
Hartlapp 487
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