On the Design of a European Health Union: Public Preferences, Trust, and Experience With the Covid-19 Crisis

During and following the Covid-19 pandemic, the European Union (EU) is taking first steps toward a European Health Union (EHU). There is no set definition of what an EHU is, but in this paper, we explore the popular support for different designs of an EHU, including a pillar in which healthcare policy competences are shared between the EU and national governments, a risk-sharing, and a redistributive pillar among countries. The analysis draws on two conjoint experiments in which respondents are presented with policy packages, as well as on a follow-up survey on political attitudes. One of the experiments focuses on a central fiscal capacity that provides financial help to countries hit by adverse shocks, including financing of national healthcare spending, while the second focuses on joint procurement of medical countermeasures. The surveys were fielded in five EU countries at the end of March/beginning of April 2020, in July 2020, and in November 2022. Our findings are the following: there is support for all three pillars of an EHU, which moreover rises with trust in the EU; respondents tend to prefer a health-related fiscal capacity to other forms of EU fiscal capacity; direct experience with serious Covid-19 infection raises both trust in the EU and support for the EU sharing in social policy competences; and more trust has a larger positive effect on support for an EHU for those without serious Covid-19 experience than for those with. These findings suggest that to promote further EU integration, the European Commission may want to develop strategies to bolster trust in the EU.