Healthcare

Prominent examples of cooperation

ZOASTs AND FRANCO-BELGIAN COOPERATION
While cross-border healthcare cooperation is found along all of France’s borders, it is particularly intensive along the Franco-Belgian border. The ratification of the healthcare framework agreement by Belgium in 2011 made it possible to establish a legal framework for healthcare cooperation.
The Transcards project, launched in Thiérache in 2000, and the Franco-Belgian Health Observatory (Observatoire franco-belge pour la Santé – OFBS) have given strong impetus to cooperation in the border region, which has been a pioneer with respect to the “Organised zones of access to cross-border healthcare” (“Zones organisés d'accès aux soins transfrontaliers” – ZOAST). There are five of them along the French-Belgian border alone.
Cooperation has developed notably thanks to the different Interreg programmes covering the zone.

On the French-German border, cross-border players are also developing two ZOAST schemes, which are in the study phase in the Strasbourg-Orteneau and SaarMoselle territories.
However, note should be taken of the recent position of the French Ministry for Health, which for financial reasons appears to be seeking to limit healthcare covered by ZOASTs to that which compensates deficits in provision on the French side,

Elsewhere, another form of French-Belgian health cooperation has developed concerning emergency medical aid, based on an emergency medical aid convention signed on 20 March 2007, and implemented in border regions (now-defunct Lorraine and Nord regions, Ardennes-Thiérache) beginning in 2008. The system enables French and Belgian mobile emergency and reanimation services to intervene on both sides of the border without distinction, in order to reduce intervention times and patients’ waiting times.

Finally, in addition to the emergency medical aid, French-Belgian cooperation has developed in the medico-social field. There is a long-established custom of welcoming French elderly people and disabled people in care homes in Belgium and particularly in Wallonia, which has generated considerable mobility from France towards this region. With a view to formalising relations, a French-Walloon cooperation framework agreement was signed in 2011 concerning welcoming disabled people in order to strengthen cooperation in this field. In order to develop better support for disabled people, encourage the pooling of resources, continuity, exchange of good practice, the objectives of the framework agreement are specifically “[to develop] new conventions of care for disabled minors, the establishing of common inspections between the French and Walloon competent authorities and a reform plan for the Walloon decree on care for disabled persons.”


THE CERDANYA CROSS-BORDER HOSPITAL

The border between France, Spain and Andorra also provides numerous examples of cross-border projects in the area of healthcare, including the emblematic example of Europe’s first cross-border hospital in Cerdanya, whose statutes were signed in April 2010 with the creation of the “Cerdanya Hospital” European Grouping of Territorial Cooperation. This hospital is located in a rural area, previously without medical or hospital facilities adapted to the needs of the resident populations (32,000 inhabitants and up to 150,000 during the tourism season). The EGTC will be able to manage other healthcare facilities within its geographic area of operation. Its members are the competent authorities in health matters from both sides of the border: the autonomous community of Catalonia, on the Spanish side, and the National Health Insurance Fund for Employees (CNAMTS), and the Agence régionale de santé (regional health authority) on the French side. The EGTC has been established for a duration of ten years, which will be renewed automatically if none of its members object. The hospital opened its doors on 19 September 2014. Its level of activity is increasing, with for example 24,000 visits to the accident and emergency department in 2015. In 2016 the Cerdanya Hospital received the prize for the best project created and realised by a European Grouping of Territorial Cooperation, awarded by the Committee of the Regions.
The development of this cross-border cooperation is also of major significance for Andorra. In order to ensure the provision of healthcare services to its nearly 78,000 inhabitants, the Principality of Andorra has entered into cooperation agreements with France and Spain, which are currently being formalised, notably via the strategic healthcare plan adopted by the principality in 2008.
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FRANCO-GERMAN COOPERATION

Following the framework agreement for health cooperation between France and Germany, which came into force in 2006, four local conventions were signed in 2009, and a fifth in 2013:

-       Between Lorraine and Saarland on emergency medical aid;

-       Between Alsace and the Ludwigshafen centre for severe burn injuries;

-       Between Alsace and Baden-Württemberg on emergency medical aid;

-       Between Alsace and Rhineland-Palatinate on emergency medical aid.

-       Between Lorraine and Saarland on cardiology matters in 2013


A convention concerning patients with epilepsy concluded between the Alsace regional health authority (ARS) and Kork (Baden-Württemberg) is currently in force.

A joint commission meets annually in order to supervise the implementation of the framework agreement. On the occasion of the January 2014 meeting in Nancy, potential projects that were considered included a ZOAST (Organised zone of access to cross-border healthcare) project, and a project for a Franco-German observatory (exchange platform, realisation of comparative studies, emergence of cooperation…)

(Source: DAEI – French Directorate for Economic and International Affairs)

COOPERATION BETWEEN EMERGENCY SERVICES

Cross-border cooperation between emergency services is another aspect of cooperation in the field of health. It has developed on French borders by way of projects like “ALARM – For Security Without Borders” between France and Belgium, launched on 1 October 2016, which aims to improve exchanges between emergency services on either side of the border. The project “ALERT – Anticipating and combatting cross-border risks in a shared territory”, launched on 17 April 2018 on the French-Spanish border, has the same objectives. The focus is on overcoming the administrative border to combat risks (both natural and related to human activity) potentially facing the populations, in order to provide emergency services strengthened by daily operational cooperation between the two countries’ services.

OTHER EXEMPLARY PROJECTS

Examples of flagship projects in the health field, highlighted in the European Commission’s study “European Cross-Border Cooperation on Health: Theory and Practice”, published in 2017:

-       The TRISAN project : TRISAN is a trinational project between France, Germany and Switzerland that aims to improve healthcare for the population of the Upper Rhine region. With this aim, a cooperation platform (centre of expertise) has been set up to provide healthcare stakeholders with operational support in the field to help set joint planning objectives and promote synergy between new networks and the existing coordination bodies. The project is running from 2016 to 2019, and benefits from funding from the Interreg VA – Upper Rhine programme.
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-       INTERSYC – “Caring for and Protecting Children Together”  (Greece, Bulgaria): The INTERSYC project, implemented by the organisation “The Smile of The Child” and its partners, aims to improve provision of care, disease prevention, and social protection at the Greece-Bulgaria border, in particular concerning children and their families. The focus is on combatting the regional isolation of the zone in terms of health, and combatting phenomena such as child abuse and child trafficking observed in the 2000s. In working toward this goal, the project involves implementing actions, seminars, and training by the different partners.
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-       Ireland–United Kingdom Cross-border health partnership: “Putting Patients, Clients and Families First” : The CAWT project aims to reduce shortfalls in access to healthcare, and health and social services in the border region between Northern Ireland and the Republic of Ireland. The CAWT partnership (Cooperation And Working Together for health gain and social well being in border areas) was formalised under the Ballyconnell Agreement of 1992, bringing together the North Eastern and North Western Health Boards in the Republic of Ireland and the Western Health and Social Services Board in Northern Ireland. This body is implementing the initiative “Putting Patients, Clients and Families First”, which includes 12 projects in health and social care cooperation across the border.
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-       Telemedicine Euroregion Pomerania (Germany, Poland) -  “Move the date, not the patients” : The Pomerania Euroregion brings together Polish and German border regions that are remote and sparsely populated (69 inhabitants per km2), that are becoming medical deserts where access to healthcare is very limited. To overcome this, the project aims to develop telemedicine in the region in order to improve access to healthcare. This involves using communications technologies to put patients in contact with geographically distant doctors, or to send patients’ data to practitioners. The goal is to improve prevention of certain diseases and to establish stable and sustainable communication with patients.
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-       Franco-German cross-border cooperation convention in cardiology : The towns of Forbach and Völklingen, both within the territory of the SaarMoselle Eurodistrict, are only 15 minutes away from each other and share a long history of cooperation, as they have been twinned since 1964. The observation that the Lorraine coalfield area showed the highest mortality rate within Lorraine for cardiovascular diseases (+20%), and excess mortality of this origin, led two hospitals to explore to what extent pooling their efforts and capabilities could improve care for patients suffering from acute myocardial infarction within the Lorraine coalfield area. This has led to a Franco-German partnership that today is saving the lives of cross-border citizens.

-       “NHL-ChirEx” project: This project, approved in April 2018 by the management authority of the Greater Region Interreg programme (for 4.5 million euros) aims to establish cooperation between university sites in the Greater Region in order to implement cross-border training modules in the different institutions, with the long-term aim of fostering the mobility of future doctors in the Greater Region.

-       ALERT project: Cross-border cooperation project between the firefighters of the Pyrénées-Atlantiques department, the government of Navarre, the government of Aragon and the provincial council of Gipuzkoa. Launched on 17 April 2018, it should span the 2018-2020 period. The lead partner in the cooperation will be the Pyrénées-Atlantiques department’s fire and rescue service (SDIS64). The agreement takes into account different areas of cooperation: mountainous, forest, urban, as well as natural hazard management. Following this, the opening of a cross-border rescue centre in Saint-Jean-Pied-de-Port is planned for November 2019.