Healthcare Access in Rural Border Regions. Realizing Patient Rights Across European Borders

Project Information

HARBOR

Grant agreement ID: 101024986

DOI

10.3030/101024986

Project closed

EC signature date 30 April 2021

Start date 1 March 2022

End date 1 May 2024

Funded under

• EXCELLENT SCIENCE - Marie Skłodowska-Curie Actions

Total cost

€ 214 158,72

EU contribution

€ 214 158,72

Coordinated by

OSLOMET - STORBYUNIVERSITETET
Norway

Periodic Reporting for period 1 - HARBOR (Healthcare Access in Rural Border Regions. Realizing Patient Rights Across European Borders)

Reporting period: 2022-03-01 to 2024-02-29

Summary of the context and overall objectives of the project

HARBOR is the first comparative study of cross-border interactions and their impact on access to healthcare in rural and disadvantaged border areas in Europe. Building on a novel conceptual framework in which cross-border mobility and cooperation are an integral part of healthcare territories, the project aims to close the gap in regional studies and social policy literature and provide an integrated approach of cross-border interactions and access to health care in rural border regions. Through a detailed comparison of two case studies in four countries (Belgium-France and Norway-Sweden), as well as a survey of Nordic and EU-wide policy developments, HARBOR provides new, gender-sensitive, comparative knowledge about how the EU, national, regional and local authorities can foster socially sustainable access to health care in rural border regions. The key objectives of this project are:
1. to identify the dynamics of cross-border health care in border regions and understand the local politics of cross-border cooperation;
2. to contribute to multi-level health policy research and foster comparison between European border regions;
3. to draft recommendations for health policy in European rural border regions.
Access to timely and affordable health care in rural and disadvantaged areas has become a primary concern in most European welfare states and is enshrined in the European Pillar of Social Rights (EPSR). However, specific issues linked to access to health care in undersupplied border regions and potential for decentralised cooperation are still overlooked. Most European border regions are either rural or semi-rural and are facing similar challenges: access to health care is often complicated by administrative divides, low population density, scattered resources, and often a greater distance to regional health care providers than similar facilities across the border. Some of these areas have therefore long-established local agreements that allow for cross-border mobility and cooperation.
The main conceptual ambition of HARBOR is therefore to construct a new integrated framework for understanding the scope, governance, and relevance of these arrangements in their local and domestic context rather than as a stand-alone cross-border phenomenon. This conceptualization of cross-border patient mobility and health care cooperation as a missing link between Europeanization and regionalization unlocks a deeper and more dynamic comparative understanding of the dynamics at play in rural border regions.

Work performed from the beginning of the project to the end of the period covered by the report and main results achieved so far

Research activities proceeded in two main phases, related to different level of policymaking with influence on cross-border mobility and cooperation. First, a comprehensive review of European and Nordic policy documents and health statistics was completed. This investigation led to a first publication on the Nordic response to the COVID-19 pandemic, which had a particularly significant impact on border cooperation in the Svinesund area. A paper on EU health policies was also presented at the CES conference of Europeanist. Second, the investigation of local interactions in the selected border regions was implemented, based on a bottom-up research design based on three main components:
i) Mapping of health care services provided in the selected cross-border areas. I gathered up-to-date information on the type of healthcare services available and travel distances.
ii) Content analysis of local policy documents such as agreements, minutes of meeting and written questions. I also collected and systematically analysed the content of local daily news articles mentioning cross-border care in the four countries’ selected border regions, including news archives dating back to the 1970s.
iii) Interviews with relevant stakeholders, including health care professionals, regional/local politicians, health authorities, hospital administrative staff and patient groups from the Svinesund and Ardennes regions, with a specific focus on stakeholders involved in emergency and maternity care.
The results from the second phase have been presented to conference and will lead to a forthcoming publication in a peer-reviewed journal. Policy recommendations have been identified, including concrete steps which would make health care provision more integrated and streamlined across rural border regions. These findings have been disseminated to a large audience at the Rural Pact webinar entitled “Enhancing access to health services in rural areas”.

Progress beyond the state of the art and expected potential impact (including the socio-economic impact and the wider societal implications of the project so far)

Most of the research on European cross-border health care focuses on the legal impact of free mobility and patient rights on national systems. Yet mobility of border residents and local cooperation initiatives remain largely unnoticed at European and national level and understudied, despite the important question they raise on the access to health care in rural border areas and despite their potential for innovative solutions.
While the overall numbers are still low, both areas included in the study have recorded locally significant cross-border mobility flows, particularly for emergency or maternity care (around half of birth in certain areas). Another indication of the local importance of cross-border healthcare is the fact that border patient mobility, which had all but ceased during the COVID-19 pandemic, have quickly returned to similar, if not higher, pre-pandemic levels.
Borders of national health systems, the study shows, are constantly being renegotiated, but indirectly. The legal framework for cooperation has remained relatively stable over the past decade. Most changes in cross-border pattern are indeed closely related to drastic changes in the domestic provision of health care. The main drivers behind cross-border mobility have been the policy changes that have affected patient access to specific services on each side of the border. Demand for cross-border care is triggered by domestic care becoming less available or accessible (such a clinic closures or modified catchment areas in France and Sweden).
Domestic institutions (and critically hospital financing rules) determine to a large extend how local stakeholders engage with cross-border care. The two cases diverge significantly in the way “receiving” providers and “sending” health authorities see cross-border care as an opportunity or a threat. If the main driver for mobility and cooperation are local, external interventions can foster cooperation by encouraging regional health authorities and local providers by supporting local cross-border projects on the long term.
By communicating these results to European, national and local health stakeholders, this research raises the specific challenges of accessing health care in rural border region and suggests that improving access to health care in border regions through supporting decentralised cooperation could have significant societal impact and policy relevance in the context of growing patient dissatisfaction and tightening budget constraints.

Border area (Ardennes, France)