Coopération transfrontalière européenne, planification nationale et maîtrise des dépenses de santé

Abstract

Many European states, including France, have chosen to publicly organize hospital care. Some of these countries have gone further, publicly organizing ambulatory care (or “city” medicine.) The European Court of Justice ruled that publicly organizing healthcare services in this way is compatible with European laws on competition, for the goal of such planning is to protect the financial equilibrium of national health insurance programs. This objective can also lead states to develop cross-border health cooperation initiatives. It is true that poor regional distribution of healthcare services compromises healthcare quality and equal access to medical service. As it is impossible to rapidly raise the number of medical practices established in underserved regions, cross-border healthcare cooperation can help to better serve frontier regions throughout Europe. This way, states can also take advantage of economies of scale, avoiding “redundant” investment on two sides of a border. Health cooperation also improves access to emergency services. Ambulance teams from neighboring regions can be called if their intervention would save time. This could be either because the team in question is already closer to the place where help is needed, or because they are already available or better equipped to help in the given situation. Finally, cross-border health cooperation should help reduce the problems linked to free mobility of patients and practitioners. This should keep healthcare systems from competing with one another, as certain financing actions and preferential tariffs, on the part of certain hospitals can otherwise attract more patients, including those who previously sought healthcare on the other side of the border. This can also cause healthcare professionals to migrate across the border, particularly where the two regions share the same language or culture, leading to a lack of services on the other side of the border and thus, less overall access to care. One third of the population of the European Union lives in a border region. It is thus easy to understand why the EU seeks to improve crossborder health cooperation. One way in which this is done is through programs called “Interreg,” financed by the European Regional Development Fund (ERDF), an organization meant to reinforce economic and social cohesion within the European Union, working to improve regional equilibrium. This provides economic incentives for countries to develop healthcare cooperation with one another. France has already signed such a treaty with Belgium, Germany, Italy, and Spain; a similar treaty with Switzerland is planned for the future.