The organisation of cooperation

Cross-border healthcare communities

A new concept has been emerging since the beginning of the 2000s, that of the “cross-border health community,” which goes well beyond cooperation by actors of two border regions to meet common needs. A cross-border community is characterised by a shared history and culture, together with a determination to strengthen the feeling of belonging through concrete, global and sustainable actions. Health can be one of the pillars of such a cross-border community. Bringing together health services located on either side of a border reduces geographical disparities by ensuring simple and equitable access to and provision of healthcare. Management and planning of healthcare provision at local level are altered.

This requires adaptation of healthcare provision and local organisation of the healthcare system to take account of all the local players and the needs of the entire population of the cross-border living area. For this it is necessary to set up local steering committees, to manage and coordinate the implementation of the cross-border health community.

The establishment of a cross-border health community is an opportunity to rationalise health services, adapt health policies to local realities, encourage the sharing of competences and expertise, and meet the specific needs of the population. This process must also allow health to be incorporated into the cross-border territory project.

One example can be found on the Franco-Italian border: the Menton hospital complex and the Local Health Authority of Imperia province have embarked on a major project to create a "cross-border healthcare community." Within this framework, a cross-border perinatal center was established in Menton in 2003.

“Organised zones of access to cross-border healthcare” (“Zones organiséEs d'accès aux soins transfrontaliers” – ZOAST)

Geographical proximity in some border regions has led local populations and healthcare institutions and professionals to put in place systems to simplify the administrative and financial aspects of accessing treatment abroad; these are known as “Organised zones of access to cross-border healthcare” (“Zones organisées d'accès aux soins transfrontaliers” – ZOAST).
The main objective of these zones is to improve access to healthcare for populations in border regions. To this end, the administrative and financial procedures for the treatment of patients in hospitals on either side of the border have been simplified.

ZOAST agreements are aimed at giving a specific population the possibility of going to a hospital located on the other side of the border to receive inpatient and/or outpatient treatment there.
Tested for the first time along the French-Belgian border in 2005, following on from the Transcards project carried out in the Thiérache region in 2000, this cooperation tool is being developed in other border areas, notably along the France-Germany border. There are currently seven ZOASTs on the France-Belgium and France-Luxembourg border, and two in preparation on the France-Germany border:

·         ZOAST Ardennes (2008)

·         ZOAST MRTW Mouscroun – Roubaix – Tourcoing Wattrelos (2008)

·         ZOAST ARLON LONGWY ou ARLWY (2008)

·         ZOAST MONS MAUBEUGE (2009)


·         ZOAST THIERACHE (2012)

·         ZOAST Littoral (2015)

·         ZOAST SaarMoselle (planned)

·         ZOAST Strasbourg-Ortenau (planned)