Cover_WHO_nr31_OK_Mise en page 1 30/10/13 14:13 Page 1 31 HOSPITALS AND BORDERS HOSPITALS The European Union (EU) Directive on the application of patients’ rights in INTERACTIONS SYSTEM AND HEALTH ON CROSS-BORDER COLLABORATION STUDIES SEVEN CASE cross-border health care explicitly calls for Member States to cooperate in cross- 31 border health care provision in border regions. Given that most cross-border Hospitals collaboration in the health care field involves secondary care, the legal text places hospitals close to national frontiers at the centre of attention. But how do hospitals interact with each other and with other health care actors across borders? Why does and Borders cross-border collaboration take place? Who actually benefits from it? And when Observatory Observatory does it work? These are the questions at the heart of the present volume. Studies Series Seven case studies examine the circumstances under which cross-border Seven case studies on collaboration is likely to work; the motivations and incentives of health care actors; cross-border collaboration and the role played by health systems, individuals and the EU in shaping cross- border collaboration. The study is original in that it produces qualitative and and health system interactions analytical scientific evidence on aspects of cross-border collaboration involving hospitals from a geographically diverse selection of cases covering 11 EU and non-EU countries (Austria, Belgium, Bulgaria, Denmark, Finland, France, Germany, Edited by the Netherlands, Norway, Romania, and Spain). Glinos and Matthias Wismar Irene A. by Edited Irene A. Glinos This book is of interest to decision-makers and field actors engaged in or considering Matthias Wismar cross-border collaboration. Questions on feasibility, desirability and implementation are at the core of the analysis. The book puts forward policy conclusions directly linked to the EU Directive on patients’ rights and proposes a “toolbox” of prerequisites necessary to start or maintain cross-border collaboration in health care. In addition to its deliberate policy perspective, it is relevant to observers and students of the intersection between the EU and domestic health systems known as cross-border health care. The research leading to these results has received funding from the EU’s Seventh Framework Programme for Research (FP7/2007-2013) under grant agreement no. 242058, grant acronym EUCBCC, ECAB project (2010-2013). The editors Irene A. Glinos is Researcher at the European Observatory on Health Systems and Policies. Matthias Wismar is Senior Health Policy Analyst at the European Observatory on Health Systems and Policies. Observatory Studies Series No. 31 eu eu Hospitals and Borders The European Observatory on Health Systems and Policies supports and promotes evidence-based health policy-making through comprehensive and rigorous analysis of health systems in Europe. It brings together a wide range of policy-makers, academics and practitioners to analyse trends in health reform, drawing on experience from across Europe to illuminate policy issues. The Observatory is a partnership that includes the Governments of Austria, Belgium, Finland, Ireland, the Netherlands, Norway, Slovenia, Spain, Sweden and the United Kingdom; the Veneto Region of Italy; the French National Union of Health Insurance Funds (UNCAM); the World Health Organization; the European Commission; the European Investment Bank; the World Bank; the London School of Economics and Political Science (LSE); and the London School of Hygiene & Tropical Medicine (LSHTM). Hospitals and Borders Seven case studies on cross-border collaboration and health system interactions Edited by Irene A. Glinos and Matthias Wismar Keywords: CASE STUDIES DELIVERY OF HEALTH CARE HEALTH CARE SYSTEMS HEALTH POLICY HOSPITALS INTERNATIONAL COOPERATION © World Health Organization 2013 (acting as the host organization for, and secretariat of, the European Observatory on Health Systems and Policies) Address requests about publications to: Publications, WHO Regional Office for Europe, UN City, Marmorvej 51, DK-2100 Copenhagen Ø, Denmark. Alternatively, complete an online request form for documentation, health information, or for permission to quote or translate, on the Regional Office web site (http://www.euro.who.int/ pubrequest). All rights reserved. The European Observatory on Health Systems and Policies welcomes requests for permission to reproduce or translate its publications, in part or in full. The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the European Observatory on Health Systems and Policies concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by the European Observatory on Health Systems and Policies in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. All reasonable precautions have been taken by the European Observatory on Health Systems and Policies to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either express or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the European Observatory on Health Systems and Policies be liable for damages arising from its use. The views expressed by authors, editors, or expert groups do not necessarily represent the decisions or the stated policy of the European Observatory on Health Systems and Policies or any of its partners. ISBN 978 92 890 0053 6 Printed in the United Kingdom Cover design by M2M Contents Acknowledgements vii List of tables, figures, boxes and maps viii List of abbreviations x List of contributors xi Part I: Setting the scene, findings and conclusions 1 Chapter 1 Hospitals and borders: an introduction to cross-border collaboration Irene A. Glinos and Matthias Wismar 3 Chapter 2 Hospital collaboration in border regions: observations and conclusions Irene A. Glinos and Matthias Wismar 11 Part II: Border region case studies 33 Chapter 3 Regional restructuring and European involvement: the ups and downs of the Braunau–Simbach hospital collaboration (Austria–Germany) Thomas Kostera and Renate Burger 35 Chapter 4 Strategic positioning and creative solutions: French patient flows to hospitals and polyclinics in the Belgian Ardennes (Belgium–France) Régine Kiasuwa and Rita Baeten 51 Chapter 5 Radiotherapy across the border: treating Danish patients in Flensburg Malteser hospital (Germany–Denmark) Uta Augustin, Dimitra Panteli and Reinhard Busse 75 Chapter 6 Official projects, grass-roots solutions: the Sami people using cross-border health services in the Teno River valley (Finland–Norway) Riikka Lämsä, Ilmo Keskimäki and Simo Kokko 93 vi Hospitals and borders: seven case studies Chapter 7 Local roots, European dreams: evolution of the Maastricht–Aachen university hospital collaboration (the Netherlands–Germany) Irene A. Glinos, Nora Doering and Hans Maarse 109 Chapter 8 Working across the Danube: Ca˘ la˘ ras¸ i and Silistra hospitals sharing doctors (Romania–Bulgaria) Adriana Galan, Victor Olsavszky and Cristian Vla˘ descu 137 Chapter 9 One hospital for the border region: building the new Cerdanya Hospital (Spain–France) José Miguel Sanjuán and Joan Gil 155 Acknowledgements The editors would like to express gratitude to the case study authors for their excellent work, dedication and enthusiasm during both the research and writing phases of this study: without their contributions and continued commitment the book would not have been possible. We would also like to thank our external reviewer, Pascal Garel, for incisive and constructive feedback on all nine chapters, and the internal reviewers, Rita Baeten and Nora Doering, for their valuable comments on Chapters 1 and 2. We are grateful to Lydia Wanstall for meticulous language editing, and to Jonathan North and Caroline White for unfailing support during the production process of the book. The study is part of the Evaluating Care Across Borders (ECAB) research project, which ran for three years from 2010 to 2013 with co-funding from the European Union's Seventh Framework Programme (FP7/2007–2013) under grant agreement no. 242058. The project looked at a diverse range of topics related to cross-border health care to understand what issues, expectations and needs patients might have when seeking health care outside their home system. A total of 13 institutions across Europe took part in the project. An overview of ECAB activities, partners and publications is available at www.ecabeurope.eu. Irene A. Glinos and Matthias Wismar List of tables, figures, boxes and maps Tables Table 2.1. Selected cross-border agreements according to relational, contractual or ownership governance modes 18 Table 3.1. German patients treated in KH Braunau (annual flows) 37 Table 3.2. Patients examined at the coronary angiography unit 39 Table 3.3. Phases of the collaboration project 47 Table 4.1. Density of health care providers in Champagne-Ardenne and France, 2009 53 Table 4.2. French