State Aid and Healthcare: between competition and constitutionalism

Guy, M ORCID: 0000-0003-0242-6366 (2026) State Aid and Healthcare: between competition and constitutionalism. In: Ghazaryan, N, van de Gronden, J, Tans, S and Veenbrink, M, (eds.) Services of General (Economic) Interest: State of Play and Current Challenges. Legal Issues of Services of General Interest Series . TMC Asser Press, The Hague. ISBN 978-94-6265-722-9

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Abstract

The recent state aid cases of Dôvera and Casa Regina Apostolorum demonstrate how competition and healthcare remains a contentious issue, highlighting tensions between both economic and social aspects, and EU and Member State competences. The approach taken by the EU courts typically emphasises total non-applicability of the state aid rules, although partial immunity via the Services of General Economic Interest (SGEI) mechanism is gaining greater recognition via cases such as Brussels Hospitals and successive Commission SGEI “packages”. With the State Aid Temporary Framework – introduced in response to the COVID-19 pandemic – support for various healthcare activities was facilitated via the Article 107(3) TFEU justifications. This chapter suggests that these three aspects – from non-applicability, via SGEI, to Article 107(3) TFEU – can offer further insight into where market forces can usefully be deployed in healthcare reform, and where these may have a detrimental effect. However, further understanding can be gained from examining constitutional aspects – not only Member State competence for healthcare under Article 168(7) TFEU, but also perceptions of “competence creep” at EU level regarding national healthcare, and implications for both levels of developing a European Health Union.
This chapter advances discussions in this area by juxtaposing “competition” and “constitutionalism” perspectives, while drawing on insights from before and during the COVID-19 pandemic.

Item Type:	Book Section
Uncontrolled Keywords:	Competition; COVID-19; European Health Union; EU; Member State; Service of General Interest; Service of General Economic Interest; State aid; Subsidiarity
Subjects:	K Law > K Law (General) R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine
Divisions:	Law and Justice Studies
Publisher:	TMC Asser Press
Date of acceptance:	1 September 2025
Date of first compliant Open Access:	30 April 2026
Date Deposited:	30 Apr 2026 07:33
Last Modified:	30 Apr 2026 07:33
Editors:	Ghazaryan, N, van de Gronden, J, Tans, S and Veenbrink, M
URI:	https://researchonline.ljmu.ac.uk/id/eprint/20967

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