Bringing society back into our understanding of European cross-border care

Abstract

We are pleased to discuss our study on the European Health Insurance Card (EHIC) and the redistributive effects of EHIC-related east-west patient and payment flows across regions and social classes. Our critics confirm our key finding: EHIC patient outflows from Eastern European (EE) to Western European result in a much higher relative burden for the budgets of EE states than outflows from WE to EEE do for WE countries. Starting from what they see as the true mission of social security coordination, however, they also tell us that we should never have studied the redistributive impact of EHIC patient and payment flows in the first place. In this response, we therefore explicate the differences between our empirical sociological perspective and our critics' normative legal approach. This is important, especially when social facts contradict normative legal assumptions as in our case. The EU laws that govern EHIC patient and payment flows are indeed based on the free movement provisions of the EU's internal market project, but our empirical findings show that its promise of "economic, social and territorial cohesion, and solidarity among Member States' contained in Article 3.3. of the Treaty of the European Union is not realized in practice in the case of east-west EHIC payment flows and patient mobility.