Council Level Opposition A Red Flag or a Paper Tiger: Patient Rights Compliance in Austria, Denmark and the Netherlands

Do Member States who oppose directives in the Council comply worse than those who don’t? Council level opposition is perceived to be a clear proxy for a national conflict with European legislation and subsequent poor compliance is dubbed “opposition through the back door”. However, previous research on this issue is predominantly quantitative and only deals with transposition timeliness or ensuing infringements from the Commission. This research undertakes a distinctly qualitative approach to compare compliance with the Patients’ rights Directive, in Austria (which blocked the Directive), Denmark and the Netherlands. Additionally, we also examine the impact of the misfit argument, since the Danish healthcare system’s misfit with the Directive is greater than that in Austria or the Netherlands. This study is based on expert interviews with representatives from the major institutions in Austria, and literature sources on compliance in Denmark and the Netherlands. Our findings indicate that Council level opposition does not predicate worse compliance. Furthermore, although Denmark’s system has greater difficulty implementing the Directive, compliance issues were limited to specific provisions. The study is informative of compliance with European Union action in healthcare policy and the impediments the Union faces, as it attempts to expand its role into this core national competence.