Opportunities and ways of cross-border co-operation in the health care sector: the Euregion Meuse Rhine

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Opportunities and ways of cross-border
co-operation in the health care sector the
Euregion Meuse Rhine

• Jacques Scheres MD PhD
• Euregional Co-ordinator AZM Maastricht

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Cross-border Health Care in the
Euregion Meuse-Rhine Topics

• The Euregion Meuse-Rhine, what is it?
• The euregional health care policy
• Cross-border activities of alliance of
  hospitals, sickness funds and others in the EMR

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Aims of the Euregions

• Improvement of the integration of the population
  on both sides of the border
• Eliminate the obstacles for cross-border
  economical, social and cultural co-operation

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The Euregion Meuse Rhine
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Euroregion Meuse Rhine
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The Euregion Meuse-Rhine is complex Europe in
Miniature

• 5 partner regions with own authorities
• 3 different national law systems (B, G, NL)
• 3 languages (G, F, NL)
• 4 different cultures (G, Flem, Wallon, NL)
• great asymmetry ( inhabitants, competences)
  
  

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Purpose of the cross-border health care policy in
the Euregion Meuse-Rhine

• improve cross-border access and cross-border
  co-operation
• remove obstacles presented by borders
• create new chances
• improve quality of life in the EMR
• which is in line with the European thought

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Cross-border health care in the Euregion
Meuse-Rhine along which ways?

• European freedom of movement of
• citizens / patients / workers, services, goods
• European jurisprudence ( f.i. Decker-Kohll )
• Euregional co-operation of care providers,
  insurers, and other organisations
• Specific supporting projects (f.i. INTERREG)

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Euregional Health Care Conference Alden Biesen
(B) 18-12-1998
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Cross-border Health Care Network in the EMR
Participating Hospitals

• Universitätsklinikum Aachen
• Academisch Ziekenhuis Maastricht (azM)
• Centre Hospitalier Universitaire de Liège (CHU)
• Ziekenhuis Oost Limburg Genk (ZOL)
• St. Nikolaus Hospital Eupen

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Cross-border Health Care in the EMR
Participating Insurers

• Belgium ( CM, SM )
• The Netherlands ( CZ , VGZ )
• Germany ( AOK, BKK, VdAK,
  etc.)

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What has been achieved already?
Insurers

• Simplification of permission and payment
  procedures ( IZOM project)
• International Health Card (AOK, CZ)
• Contracts with hospitals abroad

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Internationale Zorgpas/GesundheitsCard of
CZ-group (NL) and AOK (G)
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• In 2001 sloot het ziekenhuis van Genk een
  speciaal contract met CZ

Opgenomen Patienten Ambulante patienten Dag-opnamen
2001 125 771 104
2002 681 (2.35) 5982 (2.33) 740 (0.33)
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Maastricht
Aachen
Tongeren
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University hospital Maastricht
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4-ärmiger Operations-Roboter Da Vinci in
Maastricht
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What has been achieved already? (1)
Hospitals

• Univ. hospitals Aachen (G) and Maastricht (NL)
• Heart surgery for children
• Maxillofacial surgery
• PET-Scan
• Gamma Knife
• Cardiovascular surgery
• (Gynaeco-oncology)

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Cross-border alliance betweenUniversitätsklinikum
Aachen azM

• Complementarity in advanced care such as
• - burns surgery
• - transplantation (heart, kidney, bone marrow)
• - metabolic disorders, etc.
• Centre of Excellence (Euregional, European) for
• - cardiovascular diseases and surgery
• - gynaeco-oncological diseases
• - medical imaging / molecular imaging, etc.

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Vision am Horizont

• Fusion der Universitätskliniken zu einem
  Euregionalen Zentrum für Spitzenmedizin

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Genk
Tongeren
Aachen
Maastricht
Liège
Eupen
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Cross-border alliance betweenA.Z.Vesalius
Tongeren (B) azM (NL)

• Patients from azM to Vesalius and v.v.
• Specialists work in both hospitals
• Education co-assistents of UM in AZV
• Training assistents of azM in AZV
• Research AZV participates in UM projects
• Within 10 years AZV part of the transnational
  university medical centre of Maastricht?

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AZVesalius Tongeren
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Cooperation (already achieved)A.Z.Vesalius
Tongeren and azM on fields of

• General surgery ( gallbladder, inguinal rupture,
  varices, etc.)
• Gynaecology
• Medical Imaging ( MRI )
• Surgery of morbid obesity
• Paediatric Intensive Care
• Throat-, nose-, ear surgery

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Verdere specialistische contacten

• Chirurgie
• Obstetrie en Gynaecologie
• Radiologie
• Oncologie (CONCERT)
• Oogheelkunde
• Neurochirurgie

• Pulmonologie
• Neurologie
• Paediatrie
• Urologie
• KNO
• Psychiatrie
• Klinische Genetica

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Grensoverschrijdende Zorg in de EMR,Wat loopt
er al? (3)

• Delivery of blood products in emergency cases
• Ambulance, trauma-heli
• Euregional Health Reports
• etc.

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Some minor and major problems to solve in cross
border ambulance service

• Dutch ambulance has horn with 3 signals, the
  Belgian only 2
• Dutch ambulance nurse may apply ALS
• Morphine on board narcotic!
• Police has no competences abroad
• Large tariff differences

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Some minor and major experiences with treatment
of foreign patients

• Cultural differences
• Patient satisfaction usually high
• Cross-border professional communication
• Cross-border integrated care (home care!)
• MRSA protocols
• Liability and its insurance
• Doctors fees out-of-pocket payments
• Budgettary punishment

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Subjects of Interreg III Project Zorg over de
Grens in de EMR

• Website with information for patients, doctors,
  a.s.o.
• www.euregiogesundheitsportal.de
• Cross-border integrated chain care
• MRSA-Network of hospitals in border areas
• Transparancy of hospital cost
• Transcultural aspects
• Euregional Quality Circle
• Oncology Circle (mammascreening, tumor biobank)

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Cross-border Health Care in the EMR Whats more
? (4)

• Cross-border contacts of patient groups
• Network Care for the Elderly
• Euregional Health Care Conferences
• Euregional Health Report of Public Health
  Services
• Euregional environmental health projects
• Co-operation in the care for drug addicts
• Co-operation of Insitutes for Higher Education

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Cross-border Health Care in the Euregion
Meuse-Rhine pilot for Europe?

• (More) free access to health care abroad
• Hospitals in the EMR co-operate
• Sickness Funds co-operate, crossborder contracts
  
• Ambulance- and Public Health Serv. co-operate
• Patients organize euregionally and participate
• Authorities are engaged and support developments

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What kind of support do we need from the Member
States and the EU?

• Engagement of national authorities!!
• Adjustment of national hospital planning systems
  to interregional co-operation (as pilots?)
• Norms for cross-border contracting
• European framework for (mutual) recognition and
  accreditation
• Monitoring of cross-border mobility in health
  care
• Creation of Network of pilot regions (AEBR, HOPE?)

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Members of the Interreg-III Project group

• Mohr Ulrich VdAK-AEV
• Peeters Guy azM
• Sass Henning UKA
• Schemken Hans-Willi AOK
• Scheres Jacques azM
• Steevens John CZ
• Stobberingh Ellen azM
• Thielen Jacques MC
• Tietje Mario TKK
• Van Camp Luc ZOL
• Vandenbergh Joep VGZ
• Van der Zanden Brigitte azM
• Wolfs Marianne St. Nikol. Hosp.

• Assent Jenny UNMS/CHU
• Au Heike AOK
• Bieler Manfred Barmer
• Blaudzun Ulrich IKK
• Bouffioux Christian CHU
• Carnotensis Patrick CML
• Coheur Alain UNMS
• Daemen Piet azM
• Engels Jürgen AOK
• Fabry Ursula UKA
• Heuschen Willy St. Nikol. Hosp.
• Hofmann Barbara BKK
• Kesenne Jos LCM
• Meyer Patrick COK

jscheres_at_knmg.nl
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Supported by

• INTEREG III Programme of the European Union and
  the Euregion Meuse-Rhine
• Provincie Limburg (NL)
• Ministerie van VWS (NL)
• Vlaamse Gemeenschap (B)
• Provincie Limburg (B)
• Ministerium der Deutschsprachigen Gemeinschaft
  Belgiens (B)
• Région Wallonne (B)
• Province de Liège (B)
• Ministerium für Gesundheit, Soziales, Frauen und
  Familie des Landes Nordrhein-Westfalen (D)