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EU Health Union and State Aid Policy: With Great(er) Power Comes Great Responsibility

Published online by Cambridge University Press:  29 December 2020

Andrea BIONDI  and
Oana ȘTEFAN Open the ORCID record for Oana ȘTEFAN [Opens in a new window]
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Abstract

This contribution evaluates whether European Union State aid policy could play a role in achieving deeper and more solidary integration in the area of public health. According to Article 107 TFEU, the powers of Member States to grant aid to help their economies are seriously limited. Exceptions to the general prohibition to grant State aid are authorised by the European Commission, which enjoys wide discretion in weighing national objectives against European integration goals. The area of public health has been shielded from the application of these rules, with activities such as the provision of health insurance failing to be considered of economic nature (see most recently the Dôvera judgment). The COVID-19 experience shows that, in cases of major health crises, State aid provisions are practically suspended, with interventions allowed in the name of the fight against the pandemic. The eventual creation of a Health Union will require the re-evaluation of the application of the State aid rules to healthcare. This paper questions whether these rules should evolve as a reflective function of strengthened competences in healthcare or whether existing regulatory powers are enough to determine the interaction between national spending policies, a solidary European Health Union and fair competition.

Type
Articles
Information
European Journal of Risk Regulation , Volume 11 , Special Issue 4: Beyond COVID-19: Towards a European Health Union , December 2020 , pp. 894 - 902
Copyright
© The Author(s), 2020. Published by Cambridge University Press

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Footnotes

*

Professor of European Law, Kings College London, Strand, London WC2R 2LS, UK.

**

Reader in European Law, Kings College London, Strand, London WC2R 2LS, UK; [email protected].

References

1 W Kissick, Medicine’s Dilemmas Infinite Needs versus Finite Resources (New Haven, CT, Yale University Press 1994).

2 ILO report on COVID-19 and healthcare systems <https://www.ilo.org/wcmsp5/groups/public/---ed_dialogue/---sector/documents/briefingnote/wcms_741655.pdf>.

3 C Christensen, R Bohmer and J Kenagy, “Will Disruptive Innovations Cure Health Care?” (2000) 78(5) Harvard Business Review 102; R Madelin, “Health Innovation: From Organization Disruption to Outcomes Value” (2019) 25(3) Eurohealth 12.

4 M Cini, “The Soft Law Approach: Commission Rule-Making in the EU’s State Aid Regime” (2001) 8 Journal of European Public Policy 192, 197.

5 J van de Gronden and M Guy, “The Role of EU Competition Law in Healthcare and the ‘Undertaking’ Concept”, (2020) Health Economics, Policy and Law 10.1017/S1744133120000079.

6 J van de Gronden, “Services of General Interest and the Concept of Undertaking: Does EU Competition Law Apply?” (2018) 41(2) World Competition 197, 203–04.

7 Joined Cases C-262/18 and C-271/18 P Commission and Slovak Republic v Dôvera ECLI:EU:C:2020:450; Joined Cases C-503/13 and C-504/13 Boston Scientific Medizintechnik ECLI:EU:C:2015:148.

8 Joined Cases C-262/18 and C-271/18 P Commission and Slovak Republic v Dôvera, Opinion of Advocate General Pikamäe ECLI:EU:C:2019:1144, paras 41–47.

9 Similarly to Case C-264/01 AOK ECLI:EU:C:2004:150.

10 Joined Cases C-180/98-C-184/98 Pavlov ECLI:EU:C:2000:428.

11 Case C-280/00 Altmark ECLI:EU:C:2003:415, para 79; Case C-518/13 Eventech ECLI:EU:C:2015:9, para 65.

12 Commission Notice on the Notion of State Aid as referred to in Article 107(1) TFEU [2016] OJ C262/1, para 196.

13 Czech Republic – Hradec Králové public hospitals (SA.37432) and Germany – Landgrafen-Klinik (SA.38035).

14 Case T-289/03 BUPA ECLI: EU: T: 2008:29.

15 Altmark, supra, note 11, paras 89–93.

16 Commission Decision of 20 December on the application of Article 106(2) of the TFEU to State aid in the form of public service compensation granted to certain undertakings entrusted with the operation of services of general economic interest [2012] OJ L7/3. See also JL Buendía and JM Panero, “The Almunia Package: State Aid and Services of General Economic Interest”, in E Szyszczak and J van de Gronden (eds), Financing Services of General Economic Interest (The Hague, TMC Asser Press 2013) pp 99–124; L Rubini, The Definition of Subsidy and State Aid WTO and EC Law in Comparative Perspective (Oxford, Oxford University Press 2009) p 320 et seq.

17 <https://ec.europa.eu/info/law/better-regulation/have-your-say/initiatives/11835-State-subsidy-rules-for-health-and-social-services-of-general-economic-interest-evaluation->.

18 Temporary Framework to support the economy in the context of the coronavirus outbreak [2020] OJ C91I/1. References based on the consolidated version as amended on 3 April 2020, 8 May 2020 and 29 June 2020.

19 A Biondi, “Governing the Interregnum: State Aid Rules and the COVID-19 Crisis” (2020) Market and Competition Law Review vol 4, issue 2, 6.

20 Case C-205/03 FENIN P, ECLI:EU:C:2006:453, paras 25–28; and Dôvera, supra, note 7.

21 Notice on the Notion of State Aid, supra, note 12, para 2.4 and SA.39913 concerning compensation of public hospitals in the region of Lazio in Italy, C (2017) 7973 final.

22 W Sauter and H Schepel, State and Market in European Union Law. The Public and Private Spheres of the Internal Market before the EU Courts (Cambridge, Cambridge University Press 2009) pp 75–83; V Hatzopolous, Regulating Services in the European Union (Oxford, Oxford University Press 2012); van de Gronden, supra, note 6.

23 D Mueller, “Constitutional Issues Regarding European Union Expansion” in B Steunenberg (ed.), Widening the European Union: Politics of Institutional Change and Reform (Abingdon, Routledge 2003) pp 42 et seq.

24 A Biondi and E Righini, “An evolutionary theory of state aid control” in A Arnull and D Chalmers (eds), The Oxford Handbook of European Law (Oxford, Oxford University Press 2015) pp 670–90.

25 See the definition of “existing aid” as per Art 1(b)(v) of Council Regulation (EU) 2015/1589 laying down detailed rules for the application of Article 108 TFEU, [2015] OJ L248/9.

26 D Gallo, “Functional Approach and Economic Activity in EU Competition Law, Today: The Case of Social Security and Healthcare” (2020) European Public Law (forthcoming).

27 Commission Regulation (EU) No 651/2014 (GBER) declaring certain categories of aid compatible with the internal market in application of Articles 107 and 108 TFEU, [2014] OJ L187/1.

28 Point 3.6.

29 Case C-654/17 P Bayerische Motoren Werke AG and Freistaat Sachsen v Commission ECLI:EU:C:2019:634.

30 See, for instance, the Commission investigation on aid granted by Spain to Air Nostrum as to enable the company to renew its fleet, SA.50707.

31 H Hofmann, G Rowe and A Türk, Administrative Law and Policy of the European Union (Oxford, Oxford University Press 2012) ch 2.

32 <https://www.fi-compass.eu/sites/default/files/publications/European%20Social%20Fund%20and%20State%20aid_0.pdf>.

33 Article 6 of Regulation 1303/2013 – Common Provisions Regulation for European Structural and Investment Funds. (CPR) [2013] OJ L347/320.

34 Arts 37, 38 and 44.

35 Art 62.

36 Art 146.

37 Case C-245/16, Nerea, ECLI:EU:C:2017:521; Case C-138/03, Italy v Commission, ECLI:EU:C:2005:714.

38 Notice on the Notion of State Aid, supra, note 12, para 60. Case C-262/12, Vent de Colère ECLI:EU:C:2013:851, paras 25 and 26.

39 Art 2(33) of the CPR cit. above.

40 L Andor, “Cohesion and Conditionality” (2017) Progressive Economy blog <https://www.academia.edu/34580524/COHESION_AND_CONDITIONALITY_IN_THE_EU>.

41 R Huguenot-Noël, A Hunter and F Zuleeg, “Can the EU structural funds reconcile growth, solidarity and stability objectives? A study on the role of conditionalities in spurring structural reforms and reducing macroeconomic imbalances” in EPC Issue Paper No. 83, October 2017, 10.13140/RG.2.2.13527.52641.

42 Notice on Notion of State Aid, supra, note 12, para 60; GBER, Recital 26.

43 Regulation 2018/1046 of the European Parliament and of the Council on the financial rules applicable to the general budget of the Union, [2018] OJ L193/1, preamble.

44 Art 209(2)(c).

45 P Bocquillon, E Brooks and T Maltby, “Speak softly and carry a big stick: hardening soft governance in EU energy and health policies” (2020) Journal of Environmental Policy & Planning 10.1080/1523908X.2020.1792860.

46 Commission Decision setting out criteria and conditions that European Reference Networks and healthcare providers wishing to join a European Reference Network must fulfil (Text with EEA relevance) [2014] OJ L147/71.

47 K Fierlbeck, “The changing contours of experimental governance in European health care” (2014) 108 Social Science & Medicine 89.

48 Directive 2011/24/EU of the European Parliament and of the Council on the application of patients’ rights in cross-border healthcare [2011] OJ L88/45.

49 C Bérut, “The EU as an opportunity: structures and uses of European soft law in French, Austrian and Irish eHealth policies” (2021) 44 West European Politics 155.

50 Commission Decision on setting up a multisectoral and independent expert panel to provide advice on effective ways of investing in health [2012] OJ C198/7.

51 M Maggetti, “The Politics of Network Governance in Europe: The Case of Energy Regulation” (2013) 37 West European Politics 497; B Eberlein and E Grande, “Beyond delegation: transnational regulatory regimes and the EU regulatory state” (2005) 12 Journal of European Public Policy 89.

52 S Burris, M Kempa and C Shearing, “Changes in Governance: A Cross-Disciplinary Review of Current Scholarship” (2008) 41 Akron Law Review 1.