Healthcare is reaching its boundaries, so look beyond the border

The fourth edition of the Cross-border Health Meet-up will take place on 18 November at the House of Connections in Groningen. The aim is to strengthen cross-border healthcare collaborations between the Netherlands and Germany. ‘The Dutch and German border regions face the same challenges but have very different healthcare systems.’

Text: Jelle Posthuma

The Cross-Border Institute of Healthcare Systems and Prevention (CBI) focuses on healthcare cooperation in the border region between the Netherlands and Germany. Stefan Pichler, Associate Professor of Public Health at the University of Groningen, is a board member at the CBI. Born in South Tyrol, on the border of Italy and Austria, he knows the challenges of a border region all too well. ‘South Tyrol is a rural area, where access to good care is relatively difficult.’

Border regions across Europe face similar problems, Pichler continues. They tend to be sparsely populated and have an ageing population. ‘This leads to staff shortages: healthcare professionals prefer to move to the economic centre of a country.’ The border regions also have a lower socioeconomic status, based on factors such as wealth, education level and labour market participation. ‘As a result, citizens are more likely to struggle with an unhealthy lifestyle and have fewer healthy life years.’

To address these differences, the CBI was established in 2019. Primarily to foster cross-border research projects by the University of Groningen and the University of Oldenburg, such as the CHARE-GD projects. 'The Dutch and German border regions face the same challenges but have very different healthcare systems. In the CHARE-GD projects, we compare these two systems.'

Big differences

One of the researchers is Alexander Fassmer. He is conducting research on German and Dutch nursing homes. Besides a literature review, questionnaires were sent to 600 randomly selected German and 600 Dutch nursing homes. ‘We asked healthcare professionals about general care, hospital transfers and end of life care.’

In the Netherlands, medical care within the nursing home is the responsibility of elder care physicians (specialist ouderengeneeskunde), while in Germany this task remains with the general practitioner (GPs). 'The two systems are very different. Physicians in Germany have a ‘normal’ population in addition to nursing home patients. German nursing homes consequently can have an average of 8 different GPs caring for their residents. Our research shows that the Dutch system, where the elder care physicians is in charge, provides better care and fewer hospital transfers.’

The research also focuses on cooperation and communication between healthcare professionals. Fassmer sees opportunities for improvement on the German side. ‘In Germany, there is not much digitalisation yet, in contrast to the Netherlands. Fax remains the most commonly used method of communication between nurses and physicians in Germany. This can definitely be improved.'

Culture

In other areas, (rapid) changes are difficult, the researcher argues. Transitions in the healthcare system lead to major organisational and financial challenges, says Fassmer. Moreover, cultural differences are not easy to overcome. He points to Advance Care Planning (ACP), a process in which patients discuss and document their wishes, goals and preferences for end-of-life care with medical professionals.

ACP is more common in the Netherlands than in Germany, Fassmer's research shows. ‘75 per cent of Dutch nursing homes offer ACP, compared to 39 per cent in Germany.’ It has to do with training opportunities, but the stance on euthanasia also plays an important role. ‘There is a strong focus on life-extending treatments while in the Netherlands the focus is on quality of life.’

According to Fassmer, the research findings provide important insights. ‘Before this project, we knew from existing collaborations that the Dutch elder care system seems to work well. The collected data definitively confirm this assumption.’ However, he does have a recommendation for future projects. ‘It is crucial that we ensure equal funding on both sides of the border. ‘In the first part of our research, there was no funding from the Dutch side, making it difficult for our Dutch colleagues to allocate time.’

Connection

The event on 18 November offers participants insights on the latest research findings from current cross-border projects. A key aim is to connect researchers, policymakers, healthcare professionals and citizens, says Pichler. This is reflected in the involvement of the Rijnland Instituut, a knowledge institute for regional development with several partners in the northern Netherlands and north-western Germany.

There are ample opportunities to strengthen cooperation between healthcare suppliers in border regions, the researcher knows. ‘It could reduce waiting lists and potentially save costs. If a patient from Leer in Germany could receive specialist treatment in Groningen instead of Munich, it would save a lot of time and money.’ However, there are still major challenges, Pichler knows, such as language barriers, bureaucratic differences and issues concerning the exchange of patient data.

According to Pichler the cross-border studies can provide important insights for policymakers. 'We want to make more impact by seeking collaborations with parties outside academia. Policymakers can really benefit from our research. Also, partly through the network of the Aletta Jacobs School of Public Health, we want to draw national policy attention to cross-border regions.'

The Cross-border Health Meet-up programme includes keynotes by Brigitte van der Zanden (director of the euPrevent Foundation) and Ulrike Junius-Walker (Hanover Medical School). The whole programme can be found on the CBI website. You can register here .

For more information:

dr. Adriana Pérez Fortis, Scientific coordinator of the Cross-border Institute of Healthcare Systems and Prevention (CBI), a.perez.fortis rug.nl