gms | German Medical Science

Objectives: Despite other political and scientific forecasts of the past two decades, public healthcare in Europe has so far only been organized cross-border in a rudimentary manner. People are mainly treated in their country of residence. Especially in border regions, due to their peripheral location and often rural settlement structure, care close to home cannot always be guaranteed in the country of residence. In most European border regions, however, there is no systematic cooperation management for cross-border cooperation in the health sector. The study aims to identify factors that promote and hinder cross-border cooperation projects in the healthcare sector on the border between the German Federal State of Saarland and the French Département Moselle, also with the perspective goal of identifying needs for action for future cooperation projects.

Material and methods: Semi-structured interviews with experts from relevant stakeholder groups and with professional activity in this field in Saarland were analyzed via qualitative content analysis.

Results: The interviews show that cooperation goals such as the introduction of a ZOAST (Zone Organisées d'Accès aux Soins Transfrontaliers), have only partially been achieved. Despite previous initiatives, difficulties in health cooperation still arise due to national border demarcations. The basic political support for cross-border cooperation in the border region appears to be predominantly given, but a lack of political awareness at the national level is having a hindering effect. Obstacles such as legal and administrative hurdles, can be compensated by strengthening competence in dealing with heterogeneous systems. To compensate for this, broad citizen participation, political awareness of the problems and the participation of local decision-making bodies could improve the situation. Economic interests were mentioned less often as hindering factors than supporting factors. Unclear, non-binding, overly ambitious or non-needs-based objectives as well as non-measurable goals proved to be obstacles to cooperation. Feasible formulations of goals and the willingness of the project partners to compromise on the objectives are conducive. The financial resources are consistently assessed as available and sufficient. Long-term staffing is a significant positive contributor. Language barriers and cultural differences were mentioned by all interviewees as obstacles.

Conclusion: In order to be able to deal with these differences, a certain cultural openness through language skills and strengthening intercultural competence is needed. Existing networks and early and broad involvement of actors are also important. The interviews suggest some approaches for improvement such as tailor-made solutions and a step-by-step cooperation that is scalable and modular, as well as including Luxembourg as a national partner. It is also possible to expand existing cooperations into the healthcare sector. These approaches confirm that border regions could play a major role as innovation laboratories for health services.