Gears of influence : the selective use of European Union instruments in domestic eHealth policy-making ; Mécanique d'une influence : les usages sélectifs de l'Union européenne dans les politiques nationales d'e-santé

Abstract

The aim of this PhD thesis is to understand how the European Union (EU) may affect domestic electronic health ('eHealth') politics and policies despite its lack of competence in this area. Over the past years, the EU has supported the use of information and communication technologies within healthcare systems through the development of numerous instruments. The key argument of this research is that selective and strategic uses of European instruments by domestic actors are the core mechanisms of Europeanisation. This hypothesis is tested using a comparative analysis of eHealth policies in France, Austria and Ireland.Through actors 'usage', the EU is likely to affect the content of public policies, power games between policy actors, or the prioritisation of policy problems. This thesis shows that three conditions explain the appearance of various instances of EU usage at the domestic level: the presence of a strong interest for actors to use external resources in their political work, a positive relationship to the European level, and a diversified structure of European instruments. If these conditions are met, the EU influence is likely to occur at every stage of the policy development process. To take into account the empirical variety of EU usage, a new model based on the multiple streams framework is presented. This model allows for an accurate definition of EU causal influence in the domestic policy-making processes. ; L'objectif de cette thèse en science politique est d'analyser l'influence de l'Union européenne (UE) sur les politiques de santé électronique nationales, autrement appelées 'politiques d'e-santé'. En effet, depuis plusieurs années, l'UE développe des instruments visant à favoriser l'introduction des technologies de l'information et de la communication dans l'organisation des soins, bien qu'elle ne dispose pas de compétences dans ce domaine. L'argument central de cette recherche est le suivant : les usages sélectifs et stratégiques des instruments européens sont le vecteur principal de ...