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The European Commission’s Communication COM(2017) 534 final states that “encouraging cooperation between the Member States to improve complementarity of their health services in border regions is a priority for the EU”. This has never been clearer than in 2020, when additional challenges have put pressure on the healthcare systems of the EU Member States and especially their border regions.

However, many and various are the obstacles that still hamper the full implementation of cross-border healthcare structures or the smooth provision of medical services in border regions.

They are mainly due to the presence of non-coordinated principles to reimburse the costs for accessing medical services in the neighboring country or of legal constraints that limit the transit of emergency means of transport across the borders. Obstacles also arise because the access to specific type of medical goods or technology on the other side of the boundary is complicated or limited.

Under the 3rd call for proposals of b-solutions, four different hurdles were selected in the thematic area of “Healthcare (including emergency services)”. The types of obstacles identified by the applicants fall in the categories identified by the COM(2017) 534 final and reproduce situations that are partially similar to those already identified in the course of the first phase of b-solutions.

The geographical distribution of the advice cases varies, as they are identified along 6 different borders and involve 6 Member States.

Interesting is the variety of applicants, they include:

  • one Euroregion;

  • one EGCT;

  • one municipality and

  • one regional authority.

Finally, in the course of the IV call for proposals of the initiative, 6 new cases were selected under under the same category. 

They were identified along 6 different European borders and addressed obstacles arising in the legal or administrative frameworks of 9 Member States

Obstacles to cross-border healthcare 

Fourth call for proposals

Click on the pictures and discover how cross-border healthcare is hindered in five European border regions

Third call for proposals

Click on the pictures and discover how cross-border healthcare is hindered along six European borders 

Our participating organisations

More obstacles from the 1st and the 2nd calls for proposals 

Pilot Actions


When EMS (emergency medical system) erase borders

Consortium of the Pyrenees Working Community

Spain - France - Andorra


Without the validation of a diploma by the Order of Doctors and Nurses of the neighbouring country, healthcare professionals from the other side of the border are not authorised to intervene anywhere except on the territory where they obtained their diploma.

Proposed Solution: 

Achieving collaboration agreements among the French State, the Spanish Autonomous Communities and the Principality of Andorra that allows the signature of a convention that erases administrative problems and makes cross-border emergency health interventions possible.


To know more click here.

Advice Cases



Ambulances without Borders: towards sustainable cooperation between emergency services 

Municipality of Woensdrecht


Obstacles related to reimbursement issues, discrepancies concerning lights and sirens and differences in education of the personnel employed, prevent the cross-border cooperation in emergency services management. Although the nearest available ambulance is just a few kilometers away – on Belgian soil – inhabitants of the Dutch town Putte have to wait for the Dutch ambulance services coming from an hospital which is almost 20 kilometers away.

To know more.​

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Cross-border health care between twin cities Valga - Valka 

Valga Municipality



At the moment medical services are not financed across Estonian-Latvian border, so patients from Latvia cannot be treated in an Estonian hospital.Differences between national healthcare systems (i.e. restrictive or inadequate domestic legislation, different organisation of insurance systems and of cost reimbursement) hamper the access of persons not being cross-border workers to health care services on the other side of the border. 

To know more.​

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Speedy mutual recognition of qualifications for heathcare professionals 

EGTC Hospital of Cerdanya



The Cerdanya Hospital is the only bi-national, public hospital existing in Europe, meaning that its mission is to provide specialised healthcare for both French and Spanish people thanks to bi-national teams of professionals. However, the absence of a standardised method of mutual recognition of qualifications prevents the creation of stable cross-border teams, limiting the effectivness of the services provided.

To know more.​




Development of trans-border water supply network

Kalvarija Municipality Administration



Current Lithuanian and Polish laws don’t describe how to get permission to build and finance a cross-border water supply network. Furthermore, according to the law practice of both Countries, local government should act following the principle: “what is not allowed is forbidden”. Therefore, it seems that it is not possible to create such a network, despite the municipalities located on the cross-border area would widely benefit of this kind of service.


To know more.​




Cross-border Emergency Medical Services  

French Regional Health Agency



The France-Belgium Convention on Cross-border emergency medical services (EMS) was signed in 2007. Despite an operational level that works very well, some regulatory obstacles keep hindering the cooperation between the two countries. In particular: it is not possible for some Belgian ambulances (112-authorized) to cross the border in order to refer patients to a healthcare facility. Furthermore, depending on the type of vehicle used for patients transportation, financial compensation cannot always be provided to the patients and is limited to the interventions of the French SMURs (Service Mobile d'Urgence et de Réanimation), meaning that the financial burden occurring would weigh directly on the patients.

To know more.​



Cross-border health care

Euroregion Nisa

Check Republic-Germany


In Šluknov tip (the most northern edge of the Czech Republic), surrounded by Germany on 3 sides, does exist only one hospital which has big financial problems and faces a potential shut down. However, despite there are two hospitals very close to border on the German side, these facilities cannot be used by Czech patients due to legislative obstacles concerning the health insurances management and the medical emergencies rescue services.

To know more.

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