1. Do EU budgetary policies induce convergence of national health systems? Dr. Patrick Jeurissen Chief Strategy Group Ministry of Health, Welfare and Sport The Netherlands

2. Slowing down: per capita health expenditures growth rates in real terms, 2000-09 and 2009-11 2 Source: OECD, 2013

3. Average growth by function of public expenditure on health, OECD countries, 2008-2011 3 Source: OECD, 2013

4. Health systems are a national responsibility but encounter spill-over effects of three EU agenda’s Public health agenda: active aging, communicable diseases, blood, organs, research etc. Internal market agenda: cross border care, private markets, professional mobility etc. Financial agenda: austerity, structural funds etc. 4

5. Policy coordination and healthcare convergence? Multiple spill-over induce the need for policy coordination Rationale for efficiencies of scale and scope: rare diseases, specialized care etc. Investments in health infrastructure (structural funds). Country specific recommendations on health systems (15 in 2013). 5

6. But ‘variety’ stays important healthcare characteristic 6 Variety has not reduced that much since the Dartmouth atlas first produced its regional variations for the US. Few comparative studies show associations between costs and quality of care; or between institutional characteristics and performance. If delivery systems become less hospital-based this may in effect increase institutional diversity. Does an increase of professional and patient mobility increase convergence? Do diverging austerity needs increase convergence?