The Organized Anarchy of Implementing EU Law: The Test Case of the Patient Rights Directive

Explaining the differences in the implementation of EU law among and within EU member states  remains one of the major puzzle in EU studies. Does it depend on the administrative capabilities or the willingness of EU member states? Does it depend on the policy preferences of key actors in the implementation phase? Or does it depend on the culture of compliance in a certain country or sector? Rather than developing a new theory specifically addressing the implementation of EU law, this paper  examines the utility of a theory from domestic decision-making research that would potentially explain these differences, the garbage can theory (GCT). The patient rights directive is selected as the ultimate test case for the theory’s utility. This directive is highly complex (according to the number of considerations) and contains a high level of discretion (considering the number of articles stating that Member States ‘may’ implement parts of this directive). In addition, the directive concerns one of the largest and most diverse policy sectors, healthcare, involving a wide range of actors. The paper will examine the transposition processes of the patients’ rights directive in a number of member states by means of qualitative case studies and thus try out the theory’s utility when EU policies are being implemented into the core of the welfare state, where political preferences are likely to be firm and salience high. The case allows us to see whether and how preferences have changed or have been formed after the solution had been taken (rationalization post-hoc). The additional advantage of a qualitative approach to the transposition process is to shed light on how Member States actually pick and choose policy instruments to meet the goals set in EU directives, which the increasingly numerous quantitative studies cannot take into account.