Abstract The EU is very good at negative integration, removing barriers to cross-border activity. But does that automatically mean the creation of a common market? We investigate the extent to which EU health care policies, which undeniably are negative integration, are creating any kind of markets in health care. Using elite interviews in the UK and Germany, we find almost no behaviour by states or stakeholders that is both competitive and attributable to EU policy. There are multiple barriers to entry and weak incentives for patients, providers or governments to respond to EU health policy with competition or entry into new markets. So there is very little response to EU law, and what there is is driven by domestic political agendas.