Unfit for Patient Rights in Cross Border Healthcare? the Universalist Healthcare Model Meets the European Union

European integration of healthcare has been greatly disputed as such and traditionally a high degree of national control has governed EU patients' right to cross border healthcare. Since the late 1990s, national healthcare systems have, however, been challenged by three sequences of EU induced change. First the Court of Justice of the European Union extended the rights to cross border healthcare. Second, a patients' rights directive was politically adopted to respond to legal integration. Thirdly, this directive was transposed in the member states. The paper examines national responses to and output of these processes of EU induced change. It does so for two seemingly similar healthcare models; the universalist healthcare states of Denmark and Spain. Four domestic factors are expected to explain national responses and legislative outputs; 1) the compatibility between EU and national institutions, 2) cultures of compliance, 3) the governance structure of the healthcare system and 4) judicial Europeanization. Although the two countries belong to the same overarching model of universalist healthcare provisions, they differ on all the other domestic factors, for which reasons the three sequences of change were responded to differently. Denmark was reluctant and protectionist through all three phases of EU-induced change, producing little domestic change and minimalist compliance. Spain, on the other hand, experienced a higher degree of judicial Europeanization and more pressure for change towards marketization of their healthcare model.