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Health service

Advised entity: EUROBEC

Having access to the hospital located in Badajoz, Spain, is fundamental for Portuguese citizens from Elvas and Campo Maior because of the distance of such hospital. The limited possibility to make use of its services affects the provision of public services of citizens in this border area and Portuguese patients must travel further away to another Portuguese city when they look for medical assistance.

Ambulance service across the Schengen border

Advised entity: DKMT Euroregion 

Cross-border rescue and transport of patients in the DKMT Euroregion is considerably complicated by the fact that Romania and Serbia are not part of the Schengen area, which makes border controls unavoidable even in emergency situations. The existing legal and administrative differences between the ambulances services as well as language barriers make cooperation even more difficult. Thus, the conclusion of an international agreement between the three countries could possibly mitigate obstacles to cooperation. 

Cross-border health insurance in the DKMT Euroregion

Advised entity: DKMT Euroregion 

In the DKMT Euroregion, differing health insurance systems in Hungary, Romania and Serbia hinder effective cross-border health care services. Usually, patients cannot be taken to hospitals on the other side of the border for treatment, even though they are closer, because health insurances do not cover foreign services.  Solutions are needed to ensure a more efficient use of capacity and to promote deeper cooperation between hospitals.

Healthcare follow-up and hospitalisation at home

Advised entity: GECT Alzette Belval

Home hospitalisation, including palliative care, is a common way for patients in France to continue their treatment at home. In this case, either a team of hospital nurses or an independent nursing service contracted by the hospital comes to the patient’s home with all the necessary equipment and performs all the treatments routinely there, in close consultation with the attending hospital doctor. However, due to legal impediments, patients who live in France but whose treating doctor is based in Luxembourg cannot benefit from this form of home hospitalisation because the French nurses have no equipment and no contact with the treating Luxembourg doctor and the independent nursing service contracts are not designed for cross-border cases.

Establishment of a cross-border healthcare center

Advised entity: GECT Alzette Belval

Demographic change is also noticeable in the healthcare sector, where there is an increasing shortage of doctors because many are retiring. In order to benefit from existing capacities on both sides of the border, the GECT Alzette Belval plans to establish a cross-border healthcare center. To be able to offer attractive working conditions for doctors, and at the same time economically worthwhile medical services for patients, it is essential to find solutions to problems resulting from the different healthcare reimbursement systems in France and Luxembourg.

French-Luxembourg emergency management community

Advised entity: GECT Alzette Belval

In the border region of the GECT Alzette Belval, the nearest French hospital is located 30 km from the border whereas the closest hospital in Luxembourg is only 5 km from the border. France and Luxembourg signed a bilateral framework agreement on cross-border health cooperation in 2016, which allows rescue services to intervene in the respective neighbouring country. However, practical obstacles to cross-border cooperation in rescue services still exist, because when an accident occurs on the French side, the emergency number only refers to the French hospital further away, so that the nearest emergency relief cannot be called.

Cross-border social security affiliations

Advised entity: GECT Alzette Belval

The region of the EGTC Alzette Belval is characterized by its high mobility of workers, which reveals several problems regarding the coordination of social security systems. On the one hand, for example, for a family living in France, difficulties arise with regard to insurance for the child if only one of the parents works in Luxembourg and therefore pays contributions to the Luxembourg health insurance agency. On the other hand, pensioners who live in France but have worked in Luxembourg throughout their careers and continue to receive health services in Luxembourg, only receive reimbursement at the often lower, French rates, even though they have contributed to the Luxembourg social security system during their working lives.

Transport and cross-border mobility at EUROBEC

Advised entity: EUROBEC 

The urban centers of Elvas (PT), Campo Maior  (PT), and Badajoz (ES) would like to develop a cross-border transport system in order to deepen the economic and territorial integration of the border region. However, the lack of competences of the cities to manage public transport across border limits its implementation, for example related to the acquisition and circulation of buses.

Cross-border public transport

Advised entity: Euregio via salina e. V.

Local authorities along the Austrian-German border face limits to develop cross-border public transport services. In particular, different contracts’ forms concluded with national public transport companies impede the creation of a uniformed ticketing system. Other obstacles relate to diverging bus stop regulations and the integration of timetable information. Addressing these hurdles would increase public mobility and entail the mitigation of congestion and pollution in the border region.

Cross-border ambulant therapeutic services

Advised entity: Euregio via salina e. V.

When intervening across the border between Austria and Germany, therapeutic service providers such as caretakers or physiotherapists have difficulties to be insured and reimbursed of their costs because of the different national billing systems to health insurances funds. This situation is particularly problematic for patients living in rural and isolated areas affected by a lack of therapeutic service providers.

Cross-border commercial passenger transport

Advised entity: Chamber of commerce, industry, crafts and agriculture of Bolzano

Taxis and rental cars with drivers travelling from Italy to Austria (and vice versa) are considered as not authorised to carry out cross-border passenger transport according to the German and Austrian authorities. Transport with vehicles with up to 9 seats such as taxis or rental cars with drivers could therefore be deemed illegal and punished with fines and confiscation of the vehicle. This creates a considerable difficulty for cross-border commercial passenger transport and by extension for tourism in the Alpine regions of Tyrol, South Tyrol and Trentino.

Sharing freshwater across the border

Advised entity: Provincie West-Vlaanderen

An agreement currently in force between Flanders and the Netherlands prevents cooperation in sharing freshwater between the two regions. This leads to situations where a farmer on Flemish territory is no longer allowed to capture water in dry periods, while his colleague on Dutch soil a few meters away does have the possibility to extract water. As a result, it hinders cooperation on the cross-border water system in the light of climate change.

Comparison of water tourism regulations on the Slovakian-Hungarian border

Advised entity: Arrabona EGTC

The Danube river and its natural branch system offer outstanding water tourism opportunities along the Hungarian-Slovak border. However, cross-border tourism in this area is currently limited due to different regulations for water hiking between the two countries (e.g. the age-related obligation to use a life jacket, personal conditions for steering watercraft).

Local tariff fee for cross-border mobility

Advised entity: Syndicat du Pays de Maurienne 

Crossing the Fréjus tunnel costs 64 euros per round trip by car as of 1 January 2023. The high fee constitutes an obstacle to the mobility of cross-border commuters and workers between Haute Maurienne in Savoie and Alta Valle di Susa in Italy. A system of ticketing adapted to the needs of the inhabitants of the border region, with lower fees for locals, would facilitate the cross-border exchanges.


French-German joint degree

Advised entity: Franco-German Institute for Technology, Economics and Science (ISFATES-DFHI)

With more than 400 students and more than 3,300 former students, the Franco-German Institute for Technology, Economics and Science (ISFATES-DFHI) is the result of a cooperation between the Hochschule für Technik und Wirtschaft des Saarlandes (htw saar) and the University of Lorraine (UL). The Institute faces a legal obstacle to issue a joint degree that satisfies both France’s and Germany’s formal requirements. This is due to the specific requirements for a 'joint' degree under French law (printing on parchment supplied by the French national printing house, signature by the Rector Chancellor of the Universities, etc). Finding a solution to that problem would preserve the philosophy of joint construction and cooperation of this Franco-German institute.

Health care for cross-border commuters

Advised entity: Junta de Extremadura

Cross border workers working in Portugal can request to benefit from health care in Spain, where they live, by filling in a form. They remain insured for 12 months and can renew their insurance once it expires. However, due to a lengthy administrative procedure to renew their insurance, these workers face the risk of not being covered for 15-30 days, which is equivalent to the period from the renewal application to reinstatement of health coverage. During these days, the workers are not insured. This creates a significant restriction of access to health care across the border.


Road to health: European solutions for cross-border rescue driving

Advised entity: EGTC European Region Tyrol-South Tyrol-Trentino

The types of driving licences required to drive ambulances heavier than 3.5 tons are different across borders. Therefore when crossing the border between Italy and Austria, for instance, the driver of an ambulance could face liability issues in case of an accident if he/she does not have the adequate licence required by the neighbouring Member State.

Harmonising the types of driving licences at the European level would create legal certainty for cross-border ambulance services and/or civil defence missions, putting cross-border cooperation on a safe legal ground.

Funding of youth psychiatric care across Dutch-German border

Advised entity: Karakter, child and adolescent psychiatry 


The German and Dutch regulations regarding access, scope of services, and reimbursement for child psychiatric treatments are very different and often incompatible. This imbalance creates high administrative difficulties and potential financial costs on parents and health insurance providers when a child who lives in Germany is seeking psychiatric treatment at the hospital Karakter on the Dutch side.

Reducing the legal and administrative barriers related to financing and recognition of treatments will enhance psychiatric care for those children living in a Dutch-German border region.

Animal health law exemptions between Netherlands and Germany

Advised entity: Cross-border nature park Maas-Swalm-Nette

Recreational horse riding is popular in the cross-border nature park Maas-Swalm-Nette, which straddles the Netherlands and Germany. However, the conditions for developing this activity are hampered, particularly due to a restriction in the European Animal Health Law that demands a health certificate issued by a veterinarian for animal crossing national borders.

In a cross-border context, such a rule impedes the promotion of recreational horse riding and limits the joint use of the territory.

Horse-riding fee

Advised entity: Cross-border nature park Maas-Swalm-Nette

The cross-border nature park Maas-Swalm-Nette covers an area along the Dutch-German border where different laws apply. Horse riders, for example, must pay a horse riding fee on the German side of the park, but not on the Dutch side. This fee is rarely known by riders from the Netherlands, putting them at danger of receiving a fine when using the German paths of the park.

The parks administrations seek for solutions that make the park equally accessible.

Public services and cross-border mobility

Advised entity: Municipality of Ventimiglia

Every day, roughly 5,000 residents of Italy's Ventimiglia basin commute to France for work, while a comparable number of people travel from France for "proximity tourism" on the Italian side. Cross-border public services (train, ferry, bus) are inadequate and insufficient because existing transportation and urban development plans do not take into consideration the particular nature of cross-border interactions.

Establishing efficient transit plans between Ventimiglia and France will ease the movement of residents and visitors from both sides of the border, resulting in considerable reductions in road traffic, congestion, and pollution.

Cross-border public transport – safety belts

Advised entity: Eurometropolis Lille-Kortrijk-Tournai

The prospect of creating or simply extending bus lines over the French-Belgian border is hindered by multiple requirements from each country. For instance, the French legal requirement  for seatbelts in vehicles entering and departing the country impedes the growth of cross-border bus links.

Such disparities must be solved in order to enable more and better cross-border public transportation that benefits the border region and its people. 

Franco-Belgian mutual recognition of lifeguards

Advised entity: Eurometropolis Lille-Kortrijk-Tournai

In the neighbouring cities of  Lille, Kortrijk and Tournai, several French schools used to travel to Belgian swimming facilities for sport classes. However, the schools were discouraged from doing so because Belgian lifeguards’ status is not recognised by French national education system.

Automatic recognition of lifeguard professional qualifications across borders would result in increased safety for the students and provide more possibilities for outstanding teaching.

EGTC as subsidising authority

Advised entity: EGTC Linieland van Waas en Hulst

Difficulties emerge in determining whether the EGTC Linieland van Waas en Hulst may legally administer funding for Dutch and Belgian farmers in the border regions, given that it is a Belgian public entity and hence not recognised as a subsidising authority under Dutch law.

Overcoming this doubt to establish the fund would enable farmers of two different nations to make polder farming resilient, sustainable and profitable, while benefiting people and the territories.

Limitations to cross the Nymfaia - Makaza Pass

Advised entity: Chamber of Commerce & Industry of Xanthi

Despite a bilateral agreement enabling the passage of small vehicles along the Border Crossing Makaza – Nymphaia between Bulgaria and Greece, larger vehicles, such as trucks and buses, are not permitted to cross. Allowing the passage of these larger vehicles would benefit the cross-border region in a variety of ways, including improving access for tourist buses to cultural and natural sites across the border, creating job opportunities for drivers and border residents, and using more sustainable modes of transportation than private vehicles.

Comparison of fishing rules on border rivers

Advised entity: Mura Region EGTC

The Mura river has been for several years the destination of a lively fishing tourism community. However, since the border between Croatia and Hungary runs through the middle of the river, regulations and conservation efforts for the same river differ greatly between each side. Overcoming these differences would greatly improve a coordinated conservation effort as well as increase the attractivity of the leisure area leading to various benefits for the region.

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