According to EU treaties, the financing and organization of healthcare are competences of the member states. Most if not all governments and a large majority of citizens in the EU prefer to keep it that way. The complex decision-making of the EU provides the manifold actors involved in healthcare systems many opportunities to block European integration of healthcare systems. Nevertheless, EU interference with national healthcare systems has expanded, ranging from patients’ rights, medical devices, quality of care, mutual recognition of diplomas to funding of health innovation. Do these instances of EU interference form steps towards the creation of a EU healthcare union? Would a EU healthcare union emerge, despite the manifold veto points, similar to the making of Social Europe and a common European higher education area? And if so, what shape is the EU healthcare union taking? Does it evolve into a new type of healthcare state, or does it resemble existing multi-level healthcare systems, such as those in Canada, Australia, the USA or Switzerland? With the help of comparative federalism (think of work by Falkner, Obinger, Leibfried & Castles, and Scharpf), the paper first discusses the difficulties to make a European healthcare union. It subsequently denotes the potential drivers of European integration with respect to healthcare. Quality of care belongs to the core of healthcare systems, because it concerns the direct provision of health services to patients. Therefore, the paper examines empirically the emerging EU quality of care policy to determine whether and what kind of EU healthcare union develops.
