Europeanization of eHealth and the role of national stakeholders: the case of the Polish healthcare system
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The European Commission (EC) supports the use of eHealth, and encouraged all European Member States to develop a national eHealth strategy. Due to the legislation of the EC, Poland also introduced a national eHealth strategy but a certain resistance from national stakeholders can be identified towards the use of eHealth. National resistances towards European regulations are often seen as great barriers for their implementation at the national level. This thesis asks the questions “How does the Europeanization of eHealth strategies influence the healthcare system of Poland, and how do national stakeholders shape its implementation?", in order to increase the knowledge base concerning the interplay between European and national institutions on the topic of eHealth. This thesis differentiated the influence of Europeanization between top-down and bottom-up processes to analyse the Polish eHealth development. Top-down Europeanization is measured in terms of the alignment of policies regarding eHealth regulation. Bottom-up Europeanization is measured via the policy beliefs, resources and strategies of national stakeholders. Polish and EC eHealth documents are analysed on the process of top-down Europeanization and semi-structured interviews are performed with four different stakeholder groups: policy makers and experts, payors (medical professionals), providers and patients to gain insights in the process of bottom-up Europeanization. The analysis of the top-down processes shows that the Polish legal system included new mandatory eHealth regulations from the EC and existing Polish regulations needed adjustment to align with the legislation of the EC. As shown, particularly financial reasons, the influence of other Member States, and the EC’s soft law measures shaped the path of eHealth implementation in Poland. The analysis of the bottom-up processes shows that difficulties emerged with the implementation of the Polish eHealth projects due to an absence of knowledge regarding project management and longterm planning at the national level and a lack of interest for eHealth from the general public. Further, a limited willingness and minor support of national stakeholders towards eHealth is identified due to a lack of stakeholder participation in the process of eHealth development. The stakeholder group of payors is mentioned as the only group that can influence the content of newly implemented Polish eHealth regulations, next to the policy makers. The results of this thesis can be used to study a wider research field regarding the role of national resistance in the implementation of EC regulations in general, and national eHealth development in particular.