Experimenting European healthcare forward. Do institutional differences condition networked governance?

Despite increasing interdependencies, national decision-makers have been reluctant to delegate healthcare competences to the supranational level in the European Union (EU). To overcome this impasse, EU institutions and member states have agreed on middle ground compromises by means of experimentalist governance. In this paper, we examine a tool of experimentalist governance in the making, i.e., the network formed by the cross-border healthcare expert group (CBHC) in the Patient Rights Directive. We ask whether interaction by means of transitive relations carrying trust, takes place and the extent to which domestic institutions, i.e., healthcare models, condition such interaction and thus learning. To examine network interactions, we use social network analysis on the basis of collected survey data on the exchange of information, advice and best practices within the CBHC network. We develop an Exponential Random Graph Model of the network to test the extent to which domestic institutions condition such interactions. For this, we conduct a cluster analysis and build a healthcare typology of EU27 plus the UK, Norway and Iceland, identifying five distinct healthcare types. We find that this type of networked governance brings EU healthcare cooperation forward, while domestic institutions greatly condition who interacts with and learns from whom.

尽管欧洲联盟（European Union）内部的相互依存度持续提升，但各国决策者仍不愿将医疗保健职权让渡至超国家层面。为破解这一僵局，欧盟机构与成员国借助实验性治理（experimentalist governance）模式达成了折中共识。本文考察一项处于构建阶段的实验性治理工具——即《患者权利指令》（Patient Rights Directive）框架下跨境医疗专家小组（cross-border healthcare expert group, CBHC）所搭建的合作网络。本研究拟探讨两大问题：其一，承载信任的传递性关系是否会催生网络互动行为；其二，各国国内制度（即医疗保健模式）在多大程度上制约此类互动乃至学习进程。为分析该网络的互动特征，研究团队基于收集到的CBHC网络内信息、建议与最佳实践交流情况的调研数据，采用社会网络分析（social network analysis）方法展开研究。本研究构建了该网络的指数随机图模型（Exponential Random Graph Model），用以检验国内制度对这类互动的制约程度。为此，研究团队开展了聚类分析（cluster analysis），并为欧盟27国、英国、挪威与冰岛构建了医疗保健类型学，最终识别出五种截然不同的医疗保健模式。研究结果显示，此类网络化治理模式推动了欧盟医疗保健合作进程，而国内制度则极大地决定了互动对象与学习对象的选择。