title: Dream vs. reality: seven case-studies on the desirability and feasibility of cross-border hospital collaboration in Europe.
abstract: Despite being a niche phenomenon, cross-border health care collaboration receives a lot of attention in the EU and figures visibly on the policy agenda, in particular since the policy process which eventually led to the adoption of Directive 2011/24/EU. One of the underlying assumptions is that cross-border collaboration is desirable, providing justification to both the European Commission and to border-region stakeholders for promoting it. The purpose of this paper is to question this assumption and to examine the role of actors in pushing (or not) for cross-border collaboration. The analysis takes place in two parts. First, the EU policies to promote cross-border collaboration and the tools employed are examined, namely (a) use of European funds to sponsor concrete border-region collaboration projects, (b) use of European funds to sponsor research which gives visibility to cross-border collaboration, and (c) use of the European Commission's newly acquired legal mandate to encourage "Member States to cooperate in cross-border health care provision in border-regions" (Art. 10) and support "Member States in the development of European reference networks between health care providers and centres of expertise" (Art. 12). Second, evidence gathered in 2011-2013 from seven European border-regions on hospital cross-border collaboration is systematically reviewed to assess the reality of cross-border collaboration - can it work and when, and why do actors engage in cross-border collaboration? The preliminary findings suggest that while the EU plays a prominent role in some border-region initiatives, cross-border collaboration needs such a specific set of circumstances to work that it is questionable whether it can effectively be promoted. Moreover, local actors make use of the EU (as a source of funding, legislation or legitimisation) to serve their needs.
authors.affiliation: European Observatory on Health Systems and Policies, Eurostation, Place Victor Hortaplein 40/10, 1060 Brussels, Belgium. Electronic address: igl@obs.euro.who.int.
authors.forename: Irene A
authors.initials: IA
authors.lastname: Glinos
authors.affiliation: European Social Observatory, 13 Rue Paul Emile Janson, 1050 Brussels, Belgium. Electronic address: baeten@ose.be.
authors.forename: Rita
authors.initials: R
authors.lastname: Baeten
mesh_terms: D004641:Emigration and Immigration; D005062:European Union; D006291:Health Policy / Q000331:legislation & jurisprudence; D006739:Hospital Administration; D006801:Humans; D007391:International Cooperation / Q000331:legislation & jurisprudence*; D019982:Organizational Case Studies
keywords: Cross-border collaboration; Health systems; Hospitals; The EU