On The Quiet Power of National Decisions: Hospitals, State Aid, and Services of General Economic Interest

Guy, M On The Quiet Power of National Decisions: Hospitals, State Aid, and Services of General Economic Interest. Journal of Law, Medicine & Ethics. ISSN 1073-1105 (Accepted)

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Abstract

The extent to which EU competition law applies in the healthcare context remains a contested question. The contemporaneous publication of the European Commission’s Evaluation of State Subsidy rules for health and social services of general economic interest (SGEI) in December 2022, and of the Court of Justice of the European Union’s April 2023 judgment in Casa Regina Apostolorum regarding state support to hospitals in Italy underscore uncertainty, and appear to indicate an impasse.
These publications unfold against the backdrop of two tensions: between state and market, and between the EU and national levels. Hospitals illustrate these tensions well due to the expansion of competition mechanisms into the hospital sector (notably expanding private provider delivery of public hospital services, often supported by “patient choice” policies), and of hospitals remaining typically local or regional in character rather than supranational.
This article provides a timely and original analysis of the Casa Regina Apostolorum judgment in light of Commission policy regarding SGEI and hospitals and how EU Member States engage with this. It offers insights into the potential legacy of Casa Regina Apostolorum, and indicates where future legal challenges may focus.

Item Type:	Article
Additional Information:	This article has been accepted for publication in Journal of Law, Medicine & Ethics. This version is published under a Creative Commons CC-BY-NC-ND licence. No commercial re-distribution or re-use allowed. Derivative works cannot be distributed.
Uncontrolled Keywords:	Healthcare; Hospitals; Subsidy; State aid; Service of General Economic Interest; EU competition policy
Subjects:	K Law > K Law (General) R Medicine > RA Public aspects of medicine
Divisions:	Law
Publisher:	Cambridge University Press
Date of acceptance:	13 April 2025
Date of first compliant Open Access:	9 June 2025
Date Deposited:	09 Jun 2025 10:53
Last Modified:	09 Jun 2025 11:00
URI:	https://researchonline.ljmu.ac.uk/id/eprint/26551

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