Health and Education Policy: Labour Markets, Qualifications, and the Struggle over Standards

  • Scott L. GreerEmail author
  • Ellen Kuhlmann


European Union (EU) health policy has rarely been made as health policy—internal market or fiscal governance policies have been far more than actions taken under the deliberately weak and relatively new treaty bases for health action. Actions taken in the name of the internal market, in particular, to do with cross-border professional mobility and research, reshape health policy and systems, and thereby health education. The result is an increasingly important continent-wide series of labour markets and piecemeal training reforms for health workers whose underpinning in harmonised education, and whose quality control, is far from clear. EU health research funding, meanwhile, has a bias towards the latter objective of industrial policy, even if that might be counterproductive from a health or public expenditure perspective.


  1. Buchan, J., Wismar, M., Glinos, I. A., & Bremner, J. (Eds.). (2014). Health Professional Mobility in a Changing Europe: New Dynamics, Mobile Individuals and Diverse Responses, Observatory Studies Series 32. Copenhagen: WHO.Google Scholar
  2. Correia, T., Dussault, G., & Pontes, C. (2015). The Impact of the Financial Crisis on Human Resources for Health Policies in Three Southern-Europe Countries. Health Policy, 119(12), 1600–1605.CrossRefGoogle Scholar
  3. De Raewe, P., Rafferty, A. M., Bariball, L., & Boiko, O. (2017). EU Accession: A Policy Window Opportunity for Nursing? Health Policy, 121(3), 292–299.CrossRefGoogle Scholar
  4. Dussault, G., & Buchan, J. (2014). The Economic Crisis in the EU: Impact on Health Workforce Mobility. In J. Buchan, M. Wismar, I. A. Glinos, & J. Bremner (Eds.), Health Professional Mobility in a Changing Europe: New Dynamics, Mobile Individuals and Diverse Responses, Observatory Studies Series 32 (pp. 35–64). Copenhagen: WHO.Google Scholar
  5. EuroHealth. (2011). Perspectives on the Professional Qualifications Directive. Available at:
  6. European Commission. (2005). DIRECTIVE 2005/36/EC OF THE EUROPEAN PARLIAMENT AND OF THE COUNCIL of 7 September 2005 on the Recognition of Professional Qualifications. Available at:
  7. European Commission. (2013). DIRECTIVE 2013/55/EU OF THE EUROPEAN PARLIAMENT AND OF THE COUNCIL of 20 November 2013 Amending Directive 2005/36/EC on the Recognition of Professional Qualifications and Regulation (EU) No 1024/2012 on Administrative Cooperation Through the Internal Market Information System (‘the IMI Regulation’). Available at:
  8. European Court of Auditors. (2009). The European Union’s Public Health Programme (2003–07): An Effective Way to Improve Health? Luxembourg: European Court of Auditors.Google Scholar
  9. Glinos, I. (2012). Worrying About the Wrong Thing: Patient Mobility Versus Mobility of Health Care Professionals. Journal of Health Services Research & Policy, 17(4), 254–256. Scholar
  10. Glinos, I. (2015). Health Professional Mobility in the European Union: Exploring the Ethics and Efficiency of Free Movement. Health Policy, 119, 1529–1536.CrossRefGoogle Scholar
  11. Glinos, I. A., Wismar, M., Buchan, J., & Rakovak, I. (2015). How Can Countries Address the Efficiency and Equity Implications of Health Professional Mobility in Europe? In Adapting Policies in the Context of the WHO Code and EU Freedom of Movement, Policy Brief. Copenhagen: WHO.Google Scholar
  12. Global Code of Practice on International Recruitment of Health Personnel. no year. Accessed 3 Aug 2017.
  13. Greer, S. L. (2006). Uninvited Europeanization: Neofunctionalism and the EU in Health Policy. Journal of European Public Policy, 13(1), 134–152.CrossRefGoogle Scholar
  14. Greer, S. L. (2012a). The European Centre for Disease Prevention and Control: Hub or Hollow Core? Journal of Health Politics, Policy, and Law, 37(6), 1001–1030.CrossRefGoogle Scholar
  15. Greer, S. L. (2012b). Polity-Making Without Policy-Making: European Union Health Care Services Policy. In J. J. Richardson (Ed.), Policy Dynamics in the European Union. Oxford: Oxford University Press.Google Scholar
  16. Greer, S. L. (2014). The Three Faces of European Union Health Policy: Policy, Markets and Austerity. Policy and Society, 33(1), 13–24.CrossRefGoogle Scholar
  17. Greer, S. L. (2017). Medicine, Public Health and the Populist Radical Right. Journal of Royal Society of Medicine, 110(8), 305–308.CrossRefGoogle Scholar
  18. Greer, S. L., & Jarman, H. (2012). Managing Risks in EU Health Services Policy: Spot Markets, Legal Certainty and Bureaucratic Resistance. Journal of European Social Policy, 22(3), 259–272.CrossRefGoogle Scholar
  19. Greer, S. L., & Jarman, H. (2016). Reinforcing Europe’s Failed Fiscal Regulatory State. In B. Dallago, G. Guri, & J. McGowan (Eds.), A Global Perspective on the European Economic Crisis (pp. 122–143). Abingdon: Routledge.Google Scholar
  20. Greer, S. L., & Kurzer, P. (Eds.). (2013). European Union Public Health Policies: Regional and Global Perspectives. Abingdon: Routledge.Google Scholar
  21. Greer, S. L., & Löblová, O. (2016). European Integration in the Era of Permissive Dissensus: Neofunctionalism and Agenda-Setting in European Health Technology Assessment and Communicable Disease Control. Comparative European Politics. Scholar
  22. Greer, S. L., & Mätzke, M. (2012). Bacteria Without Borders: Communicable Disease Politics in Europe. Journal of Health Politics, Policy and Law, 37(6), 887–915.CrossRefGoogle Scholar
  23. Greer, S. L., Fahy, N., Elliott, H., Wismar, M., Jarman, H., & Palm, W. (2014). Everything You Always Wanted to Know About European Union Health Policy but Were Afraid to Ask. Brussels: European Observatory on Health Systems and Policies.Google Scholar
  24. Greer, S. L., Jarman, H., & Baeten, R. (2016). The New Political Economy of Health Care in the European Union: The Impact of Fiscal Governance. International Journal of Health Services, 46(2), 262–282. Scholar
  25. Greer, S. L., Vasev, N., & Wismar, M. (2017). Fences and Ambulance: Governance for Intersectoral Action on Health. Health Policy, 11, 1101–1104.CrossRefGoogle Scholar
  26. Hancké, B. (2013). Unions, Central Banks, and EMU: Labour Market Institutions and Monetary Integration in Europe. Oxford: Oxford University Press.CrossRefGoogle Scholar
  27. Helderman, J.-K. (2015). The Crisis as a Catalyst for Reframing Health Care Policies in the European Union. Health Economics, Policy and Law, 10(1), 45–59.CrossRefGoogle Scholar
  28. Hervey, T. K. (2016). Telling Stories About European Union Health Law: The Emergence of a New Field of Law. Comparative European Politics, 15(3), 352–369.CrossRefGoogle Scholar
  29. Hervey, T. K., & McHale, J. V. (2015). European Union Health Law: Themes and Implications. Cambridge: Cambridge University Press.CrossRefGoogle Scholar
  30. Hervey, T. K., Young, C. A., & Bishop, L. E. (Eds.). (2017). Research Handbook on EU Health Law and Policy. Cheltenham: Edward Elgar.Google Scholar
  31. Humphries, N., Tyrrell, E., McAleese, S., Bidwell, P., Thomas, S., Normand, C., & Brugha, R. (2013). A Cycle of Brain Gain, Waste and Drain – A Qualitative Study of Non-EU Migrant Doctors in Ireland. Human Resources for Health, 11, 63.CrossRefGoogle Scholar
  32. Hurwitz, L. (1990). The Free Circulation of Physicians Within the European Community. Aldershot: Avebury.Google Scholar
  33. Koumenta, M., & Pagliero, M. (2017). Measuring Prevalence and Labour Market Impacts of Professional Regulation in the EU. Tender 483/PP/GRP/IMA/15/15121, Funded by the European Commission.Google Scholar
  34. Kuhlmann, E., & Larsen, C. (2015). Why We Need Multi-Level Health Workforce Governance: Case Studies from Nursing and Medicine in Germany. Health Policy, 119(12), 1636–1644.CrossRefGoogle Scholar
  35. Kuhlmann, E., Batenburg, R., Groenewegen, P. P., & Larsen, C. (2013). Bringing a European Perspective to the Health Human Resources Debate: A Scoping Study. Health Policy, 110, 6–13.CrossRefGoogle Scholar
  36. Kuhlmann, E., Maier, C. B., Dussault, G., Larsen, C., Pavolini, E., & Ungureanu, M. (2017). EU Law, Policy and Health Professional Mobility. In T. K. Hervey, C. A. Young, & L. E. Bishop (Eds.), Research Handbook on EU Health Law and Policy (pp. 111–133). Cheltenham: Edward Elgar.CrossRefGoogle Scholar
  37. Maier, C. B., Glinos, I. A., Wismar, M., Bremner, J., Dussault, G., & Figueras, J. (2011). Cross-Country Analysis of Health Professional Mobility in Europe: The Results. In M. Wismar, C. B. Maier, I. A. Glinos, G. Dussault, & J. Figueras (Eds.), Health Professional Mobility and Health Systems: Evidence from 17 European Countries (pp. 23–66). Observatory Studies Series 23. Copenhagen: WHO.Google Scholar
  38. McKee, M., & Stuckler, D. (2017) ‘Enemies of the People?’ Public Health in the Era of Populist Politics. Comment on ‘The Rise of Post-Truth Populism in Pluralist Liberal Democracies: Challenges for Health Policy’. International Journal of Health Policy and Management, 6(11), 669–672.CrossRefGoogle Scholar
  39. Merçay, C., Dumont, J.-C., & Lafortune, G. (2016). Trends and Policies Affecting the International Migration of Doctors and Nurses to OECD Countries. In OECD (Ed.), Health Workforce Policies in OECD Countries: Right Jobs, Right Skills, Right Places (pp. 103–124). OECD Health Policy Studies. Paris: OECD Publishing. Available at:
  40. Mossialos, E., Govin, P., Baeten, R., & Hervey, T. K. (Eds.). (2010). Health Systems Governance in Europe: The Role of EU Law and Policy. Cambridge: Cambridge University Press.Google Scholar
  41. Nolte, E., Knai, C., & Saltman, R. B. (Eds.). (2014). Assessing Chronic Disease Management in European Health Systems. Concepts and Approaches. World Health Organization (Acting as the Host Organization for, and Secretariat of, the European Observatory on Health Systems and Policies).Google Scholar
  42. OECD (Ed.). (2016). Health Workforce Policies in OECD Countries: Right Jobs, Right Skills, Right Places (pp. 103–124). OECD Health Policy Studies. Paris: OECD Publishing. Available at:
  43. OECD – Organisation for Economic Co-operation and Development. (2017). OECD Health Statistics Online Database, 2015, 2016, 2017.Google Scholar
  44. Santic-Milicevic, M. M., Terzic-Supic, Z. J., Matejic, B. R., Vasic, V., & Ricketts, T. C. (2014). First- and Fifth Year Medical Students’ Intention for Emigration and Practice Abroad: A Case Study of Serbia. Health Policy, 118, 173–183.CrossRefGoogle Scholar
  45. Schmidt, V. A. (2016). Reinterpreting the Rules ‘by Stealth’ in Times of Crisis: A Discursive Institutionalist Analysis of the European Central Bank and the European Commission. West European Politics, 39(5), 1032–1052. Scholar
  46. Ungureanu, M. I., Paina, L., & Olsavsky, V. (2015). Health Workforce Management in Romania. The Lancet, 386(1009), 2139–2140.CrossRefGoogle Scholar
  47. WHO. (2010). WHO Global Code of Practice on the International Recruitment of Health Personnel. Geneva: WHO (63rd World Health Assembly, WHA63.16). Available at:
  48. WHO – World Health Organization. (2016a). WHO Global Strategy on Human Resources for Health: Workforce 2030; 2016a. Accessed 3 Aug 2017.
  49. WHO – World Health Organization Regional Office for Europe. (2016b). European Framework for Action on Integrated Health Services Delivery: An Overview; 2016b. Accessed 3 Aug 2017.
  50. Wismar, M., Maier, C. B., Glinos, I. A., Dussault, G., & Figueras, J. (Eds.). (2011). Health Professional Mobility and Health Systems: Evidence from 17 European Countries. Copenhagen: WHO.Google Scholar
  51. Wismar, M., Glinos, I. A., & Sagan, A. (Eds.). (2018: Forthcoming). Patients, Peers, Professionals: Skill-Mix Innovations and Developments in Primary and Chronic Care Settings. Brussels: European Observatory on Health Systems and Policy.Google Scholar
  52. Wissenschaftsrat. (2012). Empfehlungen zu hochschulischen Qualifikationen für das Gesundheitswesen. Berlin: Wissenschaftsrat. Available at:
  53. Zeitlin, J., & Vanhercke, B. (2014). Socializing the European Semester? Economic Governance and Social Policy Coordination in Europe. Providence: Brown University, Watson Center for International Studies.Google Scholar

Copyright information

© The Author(s) 2019

Authors and Affiliations

  1. 1.School of Public HealthUniversity of MichiganAnn ArborUSA
  2. 2.Medizinische Hochschule HannoverHannoverGermany

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