Policy-making in the EU has been depicted as being starkly fragmented: initiatives are drafted in separate Directorates-General of the EU Commission, discussed in specific policy communities and decided upon in sectoral European Parliament Committees and Council formations. At the same time, we see growing numbers of complex policy problems that require cross-sectorally integrated solutions. This article argues that there are good grounds to expect policy-making in the EU Commission to favour fragmented solutions, while diffuse public interests will tend to push for integrated policies. However, it is only under specific constellations that the EU Commission will respond to these interests. The argument will be demonstrated using case study material on three policy instruments that address trans-border healthcare policy. While the Coordination of Social Security Systems Regulation and the Services in the Internal Market Directive favour largely fragmented solutions, the Patient Mobility Directive takes a more integrated approach.

Points for practitioners

Today, complex policy problems often demand integrated policy solutions that cut across organizational borders and areas of responsibility. At the same time, decision-making is often easier if policy solutions remain fragmented.

Internal coordination is an important means for public administrations to reach integrated instead of fragmented policy solutions.

Periods with high public attention are more likely to lead to more integrated policy solutions, since policy-makers will seize internal coordination to anticipate the interests of a wider public that is following the policy-making process. Evidence is provided from drafting processes inside the EU Commission on trans-border healthcare acts.