Subnational responsibilities for healthcare and Austria's rejection of the EU's patients' rights Directive

In 2011, Member States and the European Parliament brought into force a Directive on the application of patients' rights in cross-border healthcare within the EU. Austria voted against this Directive even though its national legislation was already in line with the rulings of the European Court of Justice which had triggered the negotiations on the Directive. Why then, in the absence of any legal constraints on adapting to it, did Austria vote against the Directive? The article argues that it was the federal structure of financing hospital infrastructure and the subnational level's influence on national position building which led to the rejection of the Directive. The article retraces the process of position building by analyzing the interaction between the national and the subnational levels and concludes that Austria's position mirrors the national struggle between both levels of government over control of the hospital sector.