1 European Co-operations in the Health Care Sector, Basel, September 27, 2005 Opportunities and ways of cross- border co-operation in the health care sector:

1European Co-operations in the Health Care Sector, Basel, September 27, 2005

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

Jacques Scheres MD PhDEuregional Co-ordinator AZM Maastricht

2European Co-operations in the Health Care Sector, Basel, September 27, 2005

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

Topics: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

3European Co-operations in the Health Care Sector, Basel, September 27, 2005

Aims of the EuregionsAims 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

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

5European Co-operations in the Health Care Sector, Basel, September 27, 2005

The Euregion Meuse RhineThe Euregion Meuse Rhine

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

Euroregion Meuse RhineEuroregion Meuse Rhine

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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)

The Euregion Meuse-Rhine is complex:The Euregion Meuse-Rhine is complex: “ “Europe in Miniature”Europe in Miniature”

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

9European Co-operations in the Health Care Sector, Basel, September 27, 2005

Cross-border health care in the Euregion Cross-border health care in the Euregion Meuse-Rhine: Meuse-Rhine: along which ways?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 ConferenceAlden Biesen (B) 18-12-1998

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Universitätsklinikum Aachen

Academisch Ziekenhuis Maastricht (azM)

Centre Hospitalier Universitaire de Liège (CHU)

Ziekenhuis Oost Limburg Genk (ZOL)

St. Nikolaus Hospital Eupen

Cross-border Health Care Network in the EMR: Cross-border Health Care Network in the EMR: Participating Hospitals Participating Hospitals

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

etc.)

Cross-border Health Care in the EMR: Cross-border Health Care in the EMR: Participating Insurers Participating Insurers

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What has been achieved already? What has been achieved already?

InsurersInsurers

Simplification of permission and payment procedures ( IZOM project)

International Health Card (AOK, CZ)

Contracts with hospitals abroad

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Internationale Zorgpas/GesundheitsCard Internationale Zorgpas/GesundheitsCard of CZ-group (NL) and AOK (G)of CZ-group (NL) and AOK (G)

15European Co-operations in the Health Care Sector, Basel, September 27, 2005

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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Aachen

Maastricht

Tongeren

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University hospital MaastrichtUniversity hospital Maastricht

18

19European Co-operations in the Health Care Sector, Basel, September 27, 2005

4-ärmiger Operations-Roboter Da Vinci in Maastricht

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What has been achieved already? (1) What has been achieved already? (1)

HospitalsHospitals

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 betweenCross-border alliance betweenUniversitätsklinikum Aachen – azMUniversitätsklinikum 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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MaastrichtTongeren

Liège Eupen

Aachen

Genk

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Cross-border alliance betweenCross-border alliance betweenA.Z.Vesalius Tongeren (B) – azM (NL) A.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 TongerenAZVesalius Tongeren

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Cooperation (already achieved)Cooperation (already achieved)A.Z.Vesalius Tongeren and azM on fields ofA.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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28European Co-operations in the Health Care Sector, Basel, September 27, 2005

Verdere specialistische contactenVerdere 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,Grensoverschrijdende Zorg in de EMR,

Wat loopt er al? (3)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 Some minor and major problems to solve in cross border ambulance servicecross 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 Some minor and major experiences with treatment of foreign patientstreatment 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 Doctor’s fees; out-of-pocket payments; Budgettary “punishment”

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Subjects of Interreg III Project Subjects of Interreg III Project “Zorg over de Grens in de EMR”“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: Cross-border Health Care in the EMR: What’s more ?What’s more ? (4) (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-Cross-border Health Care in the Euregion Meuse-Rhine: pilot for Europe?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 What kind of support do we need from the Member States and the EU?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?)

36European Co-operations in the Health Care Sector, Basel, September 27, 2005

Members of the Interreg-III Project groupMembers of the Interreg-III Project group

Assent Jenny UNMS/CHUAu Heike AOKBieler Manfred BarmerBlaudzun Ulrich IKK Bouffioux Christian CHUCarnotensis Patrick CMLCoheur Alain UNMSDaemen Piet azMEngels Jürgen AOKFabry Ursula UKAHeuschen Willy St. Nikol. Hosp.Hofmann Barbara BKKKesenne Jos LCMMeyer Patrick COK

Mohr Ulrich VdAK-AEVPeeters Guy azMSass Henning UKASchemken Hans-Willi AOKScheres Jacques azMSteevens John CZ Stobberingh Ellen azMThielen Jacques MCTietje Mario TKK Van Camp Luc ZOLVandenbergh Joep VGZVan der Zanden Brigitte azM

Wolfs Marianne St. Nikol. Hosp.

[email protected]

37European Co-operations in the Health Care Sector, Basel, September 27, 2005

Supported by: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)