Evaluating care across borders



Ricardo Rodrigues


Andrea E. Schmidt, Kai Leichsenring, Maria M. Hofmarcher, Pieter Vanhuysse, Gabriele Schmied, Flip Maas, Juliane Winkelmann


The London School of Economics and Political Science


The London School of Economics and Political Science (United Kingdom)

European Observatory on Health Systems & Policies (Belgium/ Denmark)

London School of Hygiene and Tropical medicine (United Kingdom)

Observatoire Social Européen (Belgium)

Universiteit Maastricht (the Netherlands)

Technische Universität Berlin (Germany)

University of Barcelona (Spain)

Institute of Public health of The Republic of Slovenia (Slovenia)

PRAXIS Center for Policy Studies (Estonia)

National Institute for Welfare and Health (Finland)

Semmelweis Egyetem (Hungary)

Regione del Veneto (Italy)


The project took as its starting point the EC Directive on Patients’ Rights, along with the existing body of research on cross-border care and existing initiatives of cross-border health care collaboration (ranging from hospitals in border areas, to migration of health care professionals, including also medicine prescription and dental care).

To identify and analyse arrangements of cooperation between actors located in different EU countries that aim to transfer patients, providers, products, services, funding or knowledge across the border which separates them. Current gaps in documentation of already existing cross-border collaboration activities as regards geographical coverage, availability and quality of data need to be addressed. On this basis a systematic in-depth analysis of the potential impact of cross-border collaboration on the wider healthcare system should be undertaken. Primary data collected in this project should close existing gaps and the findings of this research should enable national and European decision-makers to correctly assess the scale of existing cross-border care cooperation and its potential implications for the national healthcare system.


The aim of ECAB is to facilitate a process whereby Europe’s citizens can make informed choices about whether to seek health care in another Member State and, if they so choose, to ensure that the administrative and clinical processes are straightforward and ensure continuity of care. It takes as its starting point the recent draft Directive on Patients’ Rights, augmented by the existing body of research on cross-border care. It then focuses on those areas where the necessary information is incomplete and seeks to fill the gaps. It is equally important to state what it does not do. It does not seek to quantify the scale of movement because our earlier research reveals this to be a dynamic area where data are often unavailable and rapidly become out of date. ECAB firstly examines five aspects of health care delivery where it is necessary for procedures to be compatible if patients are to be assured that the care they receive is safe, of adequate quality, and capable of providing continuity where some parts of the overall care process are provided in different Member States.
These are: provisions with regard to

  • the continuing quality of health professionals,
  • treatment pathways,
  • public reporting of quality,
  • content and scope of medical records, and
  • medical prescribing.

Secondly, it looks at three areas where there is already cross-border collaboration, to identify practical issues that have arisen and how they have, or have not been addressed. These areas of practice are collaborations between hospitals in border areas, telemedicine, and dentistry. The research on the first set of topics generally takes place on two levels. The first involves a series of pan-European surveys to identify the nature of the phenomenon in, as far as possible, all Member States. The second involves focused studies in key subject areas that capture important issues. The methods used are both quantitative and qualitative and involve contributions from a broad range of disciplines. There is a strong emphasis on dissemination of policy-relevant findings, taking advantage of the strong existing links of the research team with national and European policy-makers.


Mix of methods ranging from qualitative research methods (e.g. semi-structured interviews) to quantitative methods (e.g. multinominal statistical regression).


A detailed description of milestones is available at the project's website here.


A summary of findings is available here.


Seventh Framework Programme, EC

The Austrian Federal Ministry of Science and Research


05/2010 – 10/2013