Germany, the Netherlands and Sweden all three discussed market oriented health care reforms. Furthermore, they all face demographic change, European integration and public debts. However, due to their particular national institutions and discourse these debates resulted in different degrees and dimensions of privatisation and profitisation in health care. Whereas the Netherlands and Germany introduced competition between insurances, Sweden introduced competition between public and newly established private providers. The European Union had limited influence. The Open Method of Coordination is negligible, while the four freedoms have small impact and the common markets results in pressure on non-wage labour costs.