How can structured cooperation between countries address health workforce challenges related to highly specialized health care?



This policy brief draws on the experience of different cross-border collaborations in highly specialized health care in order to address health workforce challenges that countries face. It identifies the factors that can enable or block structured cooperation and describes the institutional framework in place. It also examines the policy implications for supporting structured cooperation in the European Union. It was written to inform discussions under the Maltese presidency of the European Union in 2017.

The brief’s key messages are:

  • Resolving health workforce challenges and improving cooperation between health professionals makes it more likely that patients will receive high-quality specialized care in their own country.
  • Voluntary structured cross-border cooperation can help address the health workforce challenges that currently force patients to travel to find appropriate care.
  • Structured cooperation works at different levels (linking countries; health care or training bodies; and/ or clusters of organizations and individuals) but is always influenced by the institutional framework in which it takes place and the underlying European and national legal and policy frameworks.
  • Evaluation of different models of structured cooperation is still scarce but policy-makers can enhance the chances of structured cooperation succeeding by reviewing the five main groups of factors that can enable or block success, specifically:
    • legal factors including differences between jurisdictions on eligibility or licensing of products and medicines;
    • political factors and the commitment to making exchanges work;
    • economic factors including price and wage differences and the availability of EU funding;
    • sociocultural factors and issues like trust, communication and language barriers which influence patient preferences and impact the level and quality of knowledge and information exchange that can be achieved; and
    • organizational factors including context, the type of delivery system and any existing (informal) networks and relations.
  • Policy-makers at a European and national level can support structured cooperation and address health workforce challenges in highly specialized care by:
    • Building highly specialized care capacity throughout the EU through structured postgraduate training exchanges as a cross-border cooperation activity;
    • Tailoring all structured cooperation to the context in which it takes place;
    • Supporting successful initiatives on a structural basis, with political and financial support from domestic authorities and/or the EU;
    • Using the grassroots experience of structured cooperation in highly specialized health care to inform macro-level policies when appropriate;
    • Promoting the exchange of good practices in cross-border cooperation in (highly specialized) health care, not least as a way of inspiring health system actors to overcome health workforce challenges to the benefit of patients and health professionals.