R1 R2 R3 R4 R5 R6 R7 R8 R9 R10 R11 R12 R13 R14 R15 R16 R17 R18 R19 R20 R21 R22 R23 R24 R25 R26 R27 R28 R29 R30 R31 R32 R33 R34 R35 R36 R37 R38 R39
health strategies were developed.(59) Whilst Malta’s EU membership has generally been evaluated in positive terms it is not known how EU membership actually impacted on the Maltese health system and whether the ongoing policy developments at EU level are of benefit to the domestic health system or to the contrary, whether they generate an unnecessary burden. (55,57) The researcher’s work as senior civil servant in the Ministry of Health in Malta provided exposure to both the high-level policy processes in Brussels and operational health system issues of immediate relevance to patients and clinicians on a daily basis. This is a privilege and burden unique to those who work in a small state setting. The tension between the growing interdependence of health systems within the EU and the reluctance, if not outright resistance, for the EU institutions to assume a greater role in policy-making in the area of health systems further motivated the researcher to explore the role of the EU in shaping domestic health systems. Initial familiarisation with the existent literature uncovered a gap around the role played by the EU in shaping policy developments in health systems of small states. Whilst the small states literature has delved into behaviour of small states within the EU and has examined issues around foreign policy, security and economic policy, no studies regarding small state health systems and the EU were traced.(60-64) The primary scope therefore became that of researching lessons learned from the Maltese experience which would be of interest to other small states within the EU. Furthermore, the current manner in which health policy within the EU is developing and the behaviour of European level stakeholders in shaping these developments create a need to explore the politics of European integration in the area of health. The ongoing struggles taking place at European level between the European Commission, which is sometimes portrayed viewed as an institution seeking to broaden the health mandate, the European Court of Justice appearing to uphold patients’ rights and MS representatives seeking to defend the sovereignty of their health care systems, often seemed distant and far removed from the daily issues crowding the health system agenda at national level. As a senior public officer in a small state, the researcher was in the unique position to concurrently experience local health system issues and European health policy development. It was therefore felt that an analysis of EU health policy development from a small MS perspective would contribute towards an understanding of the desired nature of future European health policy as perceived from the lens of a small state. This experience led to the formulation of the central research aim for this dissertation, namely: “To explore the influence of EU policy on domestic health systems from a small MS perspective” The implications from the findings of this dissertation are expected to be of wider relevance to the further development of health policy at EU level as well as being of interest to other small states in the EU. 12 | Chapter 1