title: EU Country Specific Recommendations for health systems in the European Semester process: trends, discourse and predictors.
abstract: In the framework of "Europe 2020", European Union Member States are subject to a new system of economic monitoring and governance known as the European Semester. This paper seeks to analyse the way in which national health systems are being influenced by EU institutions through the European Semester. A content analysis of the Country Specific Recommendations (CSRs) for the years 2011, 2012, 2013 and 2014 was carried out. This confirmed an increasing trend for health systems to feature in CSRs which tend to be framed in the discourse on sustainability of public finances rather than that of social inclusion with a predominant focus on the policy objective of sustainability. The likelihood of obtaining a health CSRs was tested against a series of financial health system performance indicators and general government finance indicators. The odds ratio of obtaining a health CSR increased slightly with the increase in level of general Government debt, with an OR 1.02 (CI: 1.01, 1.03; p=0.007) and decreased with an increased public health expenditure/total health expenditure ratio, with an OR 0.89 (CI: 0.84, 0.96; p=0.001). The European Semester process is a relatively new process that is influencing health systems in the European Union. The effect of this process on health systems merits further attention. Health stakeholders should seek to engage more closely with this process which if steered appropriately could also present opportunities for health system reform.
authors: Department of International Health, CAPHRI School for Public Health and Primary Care, Maastricht University, 30 Duboisdomein, Maastricht, The Netherlands; Department of Health Services Management, Faculty of Health Sciences, University of Malta c/o Mater Dei Hospital, MSD 2090 Msida, Malta; Directorate for Health Information and Research, 95 G'Mangia Hill, PTA 1313 G'Mangia, Malta. Electronic address: Natasha.azzopardi-muscat@um.edu.mt.
authors: Natasha
authors: N
authors: Azzopardi-Muscat
authors: Department of International Health, CAPHRI School for Public Health and Primary Care, Maastricht University, 30 Duboisdomein, Maastricht, The Netherlands. Electronic address: Timo.clemens@maastrichtuniversity.nl.
authors: Timo
authors: T
authors: Clemens
authors: Directorate for Health Information and Research, 95 G'Mangia Hill, PTA 1313 G'Mangia, Malta. Electronic address: Deborah.stoner@gov.mt.
authors: Deborah
authors: D
authors: Stoner
authors: Department of International Health, CAPHRI School for Public Health and Primary Care, Maastricht University, 30 Duboisdomein, Maastricht, The Netherlands. Electronic address: Helmut.brand@maastrichtuniversity.nl.
authors: Helmut
authors: H
authors: Brand
mesh_terms: D003695:Delivery of Health Care / Q000191:economics*; D005060:Europe; D005062:European Union; D006078:Government Programs; D005102:Health Expenditures / Q000639:trends*; D006291:Health Policy / Q000191:economics; D006801:Humans; D017150:Public Sector / Q000191:economics; D011787:Quality of Health Care; D013223:Statistics as Topic
keywords: Country Specific Recommendations; European Semester; European Union; Health care reform; Health expenditures; Health policy; Health systems