Aim: The pilot project for a cross-border health
region Lörrach-Basel, planned over a threeyear
period, was implemented to reduce the
border effect with respect to the health care
sector for the citizens of the Trinational Eurodistrict
Basel. Persons with statutory health
insurance who live in the German district of
Lörrach and the cantons of Basel are entitled
to take part. Six German and 22 Swiss statutory
health insurance companies and 14 German
and 8 Swiss institutions of acute hospital
care and rehabilitation participate, so that
400 000 citizens may take part. From projects
within the European Union (EU) a number
of barriers and facilitators are known to promote
the success of transnational health care
concepts or to hinder it. With the aim of creating
a common health region, the pilot project
deals with the questions as to how far and under
what conditions health care in the neighbouring
country can be made available to persons
with statutory health insurance in future.
Methods: The pilot project is analyzed by the
Swiss Health Observatory (Obsan), and in Germany
by the KC-Q. The instruments for evaluation
in the multimodal evaluation concept
were developed in cooperation. For 2007, the
first year of the project, 520 data sets were
collected from applications for cross-border
care and data from expert interviews with
the German representatives of the binational
project management and all German health
insurance companies involved.
Results: The applications involved a broad
spectrum of health care offers. Predominantly
orthopaedic treatment (22%) was applied
for. The top ten diagnoses accounted for
44% of the treatment spectrum. The initiative
for treatment abroad was mainly (60%)
taken by the insured persons themselves.
11 treatment applications were consistent
with the conditions stipulated by the pilot
project. More than 97% of the applicants for
cross-border health care hold a complementary
private health insurance for treatment
abroad. Neither problems with the medical
treatments nor increases in medical risk were
observed.
Discussion: Cross-border care paid for via
complementary private health insurance
exceeded by far the cases resulting from
and complying with the project conditions.
The favourable factors realized in this project
include unbureaucratic procedures and support
by national and local politics. The summing
up of factors considered to hinder effectiveness
lists areas which need to be dealt
with because they are relevant for success of
the project: e.g. familiarity with and trust in
the health care structures in the neighbouring
country.
Conclusions: The consideration of options
and barriers suggests new ways of structuring
cross-border health regions. A good database
is needed for realization and further
development of the appropriate framework.
