Opportunities and ways of crossborder cooperation in the

Opportunities and ways of crossborder co-operation in the health care sector: the Euregion Meuse Rhine Jacques Scheres MD Ph. D Euregional Co-ordinator AZM Maastricht European Co-operations in the Health Care Sector, Basel, September 27, 2005

Cross-border Health Care in the Euregion Meuse-Rhine Topics: l The Euregion Meuse-Rhine, what is it? l The euregional health care policy l Cross-border activities of alliance of hospitals, sickness funds and others in the EMR European Co-operations in the Health Care Sector, Basel, September 27, 2005

Aims of the Euregions l Improvement of the integration of the population on both sides of the border l Eliminate the obstacles for cross-border economical, social and cultural co-operation European Co-operations in the Health Care Sector, Basel, September 27, 2005

European Co-operations in the Health Care Sector, Basel, September 27, 2005 4

The Euregion Meuse Rhine European Co-operations in the Health Care Sector, Basel, September 27, 2005 5

Euroregion Meuse Rhine European Co-operations in the Health Care Sector, Basel, September 27, 2005 6

The Euregion Meuse-Rhine is complex: “Europe in Miniature” l 5 partner regions with own authorities l 3 different national law systems l 3 languages l 4 different cultures (G, Flem, Wallon, NL) l great asymmetry ( inhabitants, competences) (B, G, NL) (G, F, NL) European Co-operations in the Health Care Sector, Basel, September 27, 2005

Purpose of the cross-border health care policy in the Euregion Meuse-Rhine: l improve cross-border access and cross-border cooperation l remove obstacles presented by borders l create new chances l improve quality of life in the EMR l which is in line with the “European thought” European Co-operations in the Health Care Sector, Basel, September 27, 2005

Cross-border health care in the Euregion Meuse-Rhine: along which ways? l European freedom of movement of citizens / patients / workers, services, goods l European jurisprudence ( f. i. Decker-Kohll ) l Euregional co-operation of care providers, insurers, and other organisations l Specific supporting projects (f. i. INTERREG) European Co-operations in the Health Care Sector, Basel, September 27, 2005

Euregional Health Care Conference Alden Biesen (B) 18 -12 -1998 European Co-operations in the Health Care Sector, Basel, September 27, 2005 10

Cross-border Health Care Network in the EMR: Participating Hospitals l Universitätsklinikum Aachen l Academisch Ziekenhuis Maastricht (az. M) l Centre Hospitalier Universitaire de Liège (CHU) l Ziekenhuis Oost Limburg Genk (ZOL) l St. Nikolaus Hospital Eupen European Co-operations in the Health Care Sector, Basel, September 27, 2005

Cross-border Health Care in the EMR: Participating Insurers l l l Belgium ( CM, SM ) The Netherlands ( CZ , VGZ ) Germany ( AOK, BKK, Vd. AK, etc. ) European Co-operations in the Health Care Sector, Basel, September 27, 2005

What has been achieved already? Insurers l Simplification of permission and payment procedures ( IZOM project) l International Health Card (AOK, CZ) l Contracts with hospitals abroad European Co-operations in the Health Care Sector, Basel, September 27, 2005

Internationale Zorgpas/Gesundheits. Card of CZ-group (NL) and AOK (G) European Co-operations in the Health Care Sector, Basel, September 27, 2005

l In 2001 sloot het ziekenhuis van Genk een speciaal contract met CZ Opgenomen Patienten Ambulante patienten Dagopnamen 2001 125 771 104 2002 681 (2. 35%) 5982 (2. 33%) 740 (0. 33%) European Co-operations in the Health Care Sector, Basel, September 27, 2005

Maastricht Tongeren Aachen European Co-operations in the Health Care Sector, Basel, September 27, 2005 16

University hospital Maastricht European Co-operations in the Health Care Sector, Basel, September 27, 2005

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4 -ärmiger Operations-Roboter Da Vinci in Maastricht European Co-operations in the Health Care Sector, Basel, September 27, 2005 19

What has been achieved already? (1) Hospitals Univ. hospitals Aachen (G) and Maastricht (NL): Heart surgery for children l Maxillofacial surgery l PET-Scan l Gamma Knife l Cardiovascular surgery l (Gynaeco-oncology) European Co-operations in the Health Care Sector, Basel, September 27, 2005

Cross-border alliance between Universitätsklinikum Aachen – az. M 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. European Co-operations in the Health Care Sector, Basel, September 27, 2005

Vision am Horizont • Fusion der Universitätskliniken zu einem Euregionalen Zentrum für Spitzenmedizin + European Co-operations in the Health Care Sector, Basel, September 27, 2005 22

Genk Tongeren Maastricht Liège Aachen Eupen European Co-operations in the Health Care Sector, Basel, September 27, 2005 23

Cross-border alliance between A. Z. Vesalius Tongeren (B) – az. M (NL) Patients Specialists Education Training Research from az. M to Vesalius and v. v. work in both hospitals co-assistents of UM in AZV assistents of az. M in AZV participates in UM projects Within 10 years AZV part of the transnational university medical centre of Maastricht? European Co-operations in the Health Care Sector, Basel, September 27, 2005

AZVesalius Tongeren European Co-operations in the Health Care Sector, Basel, September 27, 2005 25

Cooperation (already achieved) A. Z. Vesalius Tongeren and az. M on fields of General surgery ( gallbladder, inguinal rupture, varices, etc. ) l Gynaecology l Medical Imaging ( MRI ) l Surgery of morbid obesity l Paediatric Intensive Care l Throat-, nose-, ear surgery l European Co-operations in the Health Care Sector, Basel, September 27, 2005

European Co-operations in the Health Care Sector, Basel, September 27, 2005 27

Verdere specialistische contacten l l l Chirurgie Obstetrie en Gynaecologie Radiologie Oncologie (CONCERT) Oogheelkunde Neurochirurgie l l l l Pulmonologie Neurologie Paediatrie Urologie KNO Psychiatrie Klinische Genetica European Co-operations in the Health Care Sector, Basel, September 27, 2005 28

Grensoverschrijdende Zorg in de EMR, Wat loopt er al? (3) l Delivery of blood products in emergency cases l Ambulance, trauma-heli l Euregional Health Reports l etc. European Co-operations in the Health Care Sector, Basel, September 27, 2005

Some minor and major problems to solve in cross border ambulance service l l l 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 European Co-operations in the Health Care Sector, Basel, September 27, 2005

Some minor and major experiences with treatment of foreign patients l l l l Cultural differences Patient satisfaction usually high Cross-border professional communication Cross-border integrated care (home care!) MRSA protocols Liability and its insurance Doctor’s fees; out-of-pocket payments; Budgettary “punishment” European Co-operations in the Health Care Sector, Basel, September 27, 2005

Subjects of Interreg III Project “Zorg over de Grens in de EMR” l l l l 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) European Co-operations in the Health Care Sector, Basel, September 27, 2005

Cross-border Health Care in the EMR: What’s more ? l l l l (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 European Co-operations in the Health Care Sector, Basel, September 27, 2005

Cross-border Health Care in the Euregion Meuse. Rhine: pilot for Europe? l (More) free access to health care abroad l Hospitals in the EMR co-operate l Sickness Funds co-operate, crossborder contracts l Ambulance- and Public Health Serv. co-operate l Patients organize euregionally and participate l Authorities are engaged and support developments European Co-operations in the Health Care Sector, Basel, September 27, 2005

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? ) European Co-operations in the Health Care Sector, Basel, September 27, 2005

Members of the Interreg-III Project group Assent Jenny UNMS/CHU Au Heike AOK Bieler Manfred Barmer Blaudzun Ulrich IKK Bouffioux Christian CHU Carnotensis Patrick CML Coheur Alain UNMS Daemen Piet az. M Engels Jürgen AOK Fabry Ursula UKA Heuschen Willy St. Nikol. Hosp. Hofmann Barbara BKK Kesenne Jos LCM Meyer Patrick COK Mohr Ulrich Vd. AK-AEV Peeters Guy az. M Sass Henning UKA Schemken Hans-Willi AOK Scheres Jacques az. M Steevens John CZ Stobberingh Ellen az. M Thielen Jacques MC Tietje Mario TKK Van Camp Luc ZOL Vandenbergh Joep VGZ Van der Zanden Brigitte az. M Wolfs Marianne St. Nikol. Hosp. jscheres@knmg. nl European Co-operations in the Health Care Sector, Basel, September 27, 2005 36

Supported by: l l l l l 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) European Co-operations in the Health Care Sector, Basel, September 27, 2005