- 168 of the Treaty on the Functioning of the European Union encourages the complementarity of health services in cross-border areas. The Directive on patients’ rights in cross-border healthcare (2011/24/EU) ensures patient mobility and access to safe and high-quality healthcare in the EU.
- In the 2014-2020 programming period, the most frequent themes in cross-border cooperation (Interreg A) in healthcare were strengthening and improving institutional cooperation and increasing innovation. Projects covered actions such as training (38%), treatment and diagnosis (22%) and equipment (17%). Beneficiaries were first and foremost professionals and then patients.
- Cross-border cooperation faces persistent obstacles that hamper the crossing of borders and cross-border mutual development. Certain cases remain particularly difficult such as the long-term care of patients.
- As the health sector is highly regulated, cross-border cooperation requires the support and involvement of a wide range of partners and specific forms of multi-actor and multi-level governance.
- Intermediaries – such as organised zones for cross-border access to health, health observatories, or other instruments – can facilitate coordination with local and national authorities.
- The recent COVID-19 crisis has demonstrated the vulnerability of cross-border mechanisms and the structural intensity of cross-border flows. It has also highlighted cases of cross-border solidarity and the EU’s response.
- Recommendations put forward in this study include simplified and disseminated information, a common cross-border language for healthcare operators, the collection and production of comparable data and mapping of healthcare institutions, the promotion of joint supply of healthcare, and the increased involvement of intermediaries.
“Everyone has the right to timely access to affordable, preventive, and curative healthcare of good quality”. This is one of the principles of the European Pillar of Social Rights Action Plan (European Commission, 2021d).
With the support of Cohesion Policy and, in particular, Interreg programmes, cross-border cooperation in healthcare has been the source of many fruitful initiatives over the last decades. These initiatives have focused on joint services, coordination of institutions or other kinds of collaboration between healthcare operators. They have improved the quality and affordability of healthcare for patients, enhanced the work of healthcare operators and lifted standards of well-being in cross-border areas despite the continued existence of obstacles limiting free circulation and cross-border cooperation in healthcare.
Objectives of the Study
The main objective of this study is to analyse the role of Cohesion Policy in cross-border cooperation in healthcare. It outlines the issue of governance related to such projects as well as the persistent obstacles to crossing the border and to mutual development. It reviews the impact of the COVID-19 pandemic. The study also examines the EU’s response to the pandemic. It identifies possible solutions and policy recommendations for improving cross-border cooperation in healthcare.
The study is based on an analysis of Interreg programmes from the last 3 programming periods followed by a detailed analysis of 135 Interreg V-A projects related to cross-border cooperation in healthcare. It refers to previous surveys, comparative studies of cross-border governance as well as institutional, academic, and grey literature. It draws on information provided during different interviews with EU experts conducted between April and September 2021. It is also based on five case studies conducted specifically for the purpose of this study by five partners of the Transfrontier Euro-Institut Network (TEIN).
Art. 168 of the Treaty on the Functioning of the European Union encourages complementarity of health services in cross-border areas. The Directive on patients’ rights in cross-border healthcare (2011/24/EU) ensures patient mobility and access to safe and high-quality healthcare in the EU. National Contact Points, various agencies and measures facilitate access to cross-border healthcare. However, EU Member States are ultimately responsible for their own health policies and the organisation of their health and social security systems.
The comparison of Interreg projects shows that the number of projects related to healthcare has increased in all Interreg programmes (A, B and C). In the healthcare-related projects financed by the Interreg V-A programme, the most frequent themes are strengthening or improving institutional cooperation and fostering innovation, particularly with regard to products, processes, systems, and research. The analysis reveals that the beneficiaries are first and foremost professionals and then patients. The identified Interreg V-A projects mainly focus on training (38%), treatment and diagnosis (22%), equipment (17%), or information, communication, and networking.
As the health sector is highly regulated for safety and budgetary reasons and very often centralised, cross-border cooperation requires the support from and partnership between a wide-range of stakeholders and partners. They are not only hospitals and medico-social institutions but also public authorities, administrative systems, and insurers. Minimal coordination can be based on conventions and partnership, but additional guarantees are required when cooperation intensifies. Therefore, specific instruments or intermediaries can be established to act as coordinators and translators liaising local and national authorities and other stakeholders, in a complex process of governance.
In addition to the issue of governance, cross-border cooperation faces obstacles that hamper the crossing of borders and mutual development. The first type of obstacles concerns free movement; the flow of or access to information; the perception of patients and health staff; different taxation or social security systems; access to health professions and the recognition of qualifications. The second type concerns the required multi-actor and multi-level coordination; the need for a sustainable and win-win support; and the search for a common professional language. Certain cases remain particularly difficult such as the long-term care of patients.
The COVID-19 pandemic highlighted the absence of comparable appropriate and harmonised data, as well as the relatively low-level of awareness cross-border workers had of their rights. It revealed the intensity of cross-border patient and medical staff flows and the capacity for solidarity that European cross-border partners could demonstrate. The European Union Coronavirus Response Investment Initiative (CRII) and Coronavirus Response Investment Initiative Plus (CRII+) were two packages of customised measures to combat the impacts of the COVID-19 pandemic in the context of Cohesion Policy, including in the area of healthcare.
The study puts forward several key recommendations.
- Improving and disseminating simplified information for cross-border patients and healthcare staff (via a manual for patients and the establishment of cross-border regional contact points);
- Adopting a common cross-border language inside medical institutions and between all cross-border healthcare operators, including healthcare institutions, insurers, health and social security systems, administrative institutions, and local authorities. This not only requires the provision of documentation in several languages but also the explanation and the “translation” of routines, rules or procedures for the provision of cross-border care;
- Developing a sustainable and comparable cross-border database based on harmonised data collection methods as well as mapping border and cross-border healthcare operators in order to make cross-border realities more visible and create new opportunities for cross-border cooperation in healthcare;
- Improving the cross-border supply of healthcare by promoting e-medicine (with the appropriate supply of training and equipment) and joint public health services in a sustainable and win-win context for operators from both sides of the border;
- Establishing European standard protocols and regular meetings to develop integrated and efficient cross-border emergency services;
- Promoting the role of intermediaries (such as organising zones for cross-border access to healthcare, European Groupings of Territorial Cooperation, health observatories, networks, or other instruments) to help disseminate good practices and coordinate cross-border cooperation in healthcare in collaboration with local and national authorities.