Patients as EU citizens? The implementation and corporatist stakeholders' perceptions of the EU cross-border health care directive in Austria.

After a series of ECJ rulings, Directive 2011/24/EU was finally adopted to regulate access and reimbursement of planned health care in another member state. Several studies have analysed the Directive's implementation and impact on national health care systems around the time of the transposition. The case of Austria is particularly interesting. Along with Portugal, Poland, and Romania, Austria voted against the Directive, even though major elements were already in line with national legislation. This paper investigates the implementation of the patients' rights Directive in Austria through the lens of public key stakeholders. The analysis goes beyond the legal implementation and traces the policy process from the Directive's adoption at EU level to the time after its national transposition. Based on a rigorous policy document analysis, the study discusses the reasons of Austria's initial denial of the Directive and addresses the perceived tensions in its application, both from a patient and health systems' perspective. Results include the stakeholders' critical opinion towards the Directive's ability to provide legal clarity and show that its practical application remains restrictive even years after transposition. By providing evidence from Austria and discussing the findings in the context of other country examples, this paper offers new insights into the role of EU health policy-making and the practical controversies concerning its implementation on national level.