Framework agreement on cross-border healthcare cooperation and its application agreement signed respectively on 27/06/2008 et 09/09/2008. Effective date: 01/12/2014
The framework agreement and its implementing agreement cover cross-border health cooperation.
These documents set out the main provisions and define:
a geographical scope:
- the Nouvelle Aquitaine and Occitanie regions in France;
- the border areas of autonomous communities of the Basque Country, Catalonia, Aragon, and the Foral community of Navarre in Spain.
a personal scope:
- any person governed by a sickness or maternity insurance scheme in one of the two countries and residing or visiting the regions listed above.
authorities competent to sign and implement cooperation agreements:
- for France: the Nouvelle Aquitaine and Occitanie regional health agencies (ARS);
- for Spain: the Councils or Départements competent in matters of Health in each of the autonomous communities of the Pays Basque, Catalonia and Aragon, and the Foral community of Navarre for Spain.
the content of the cooperation agreements:
- they coordinate cooperation between health structures and resources located in the border regions that may be part of a care network;
- to this end, they may provide for complementarity between existing health structures and resources, and the creation and financing of cooperation entities, cross-border healthcare institutions or joint structures;
- they set out the terms and conditions applicable to the intervention of care structures, social security bodies and healthcare professionals, as well as care provided to patients; these terms and conditions may concern the following topics: territorial and personal scope to which agreements apply;
- cross-border intervention of healthcare professionals, including aspects relating to status;
- conditions for professionals' mobility;
- nature and duration of professionals' participation;
- conditions for participating in hospital emergencies and the continuity of care for salaried and liberal healthcare professionals.
- organisation of emergency services and healthcare transport for patients:
- these conditions for intervention aim to provide first aid to individuals experiencing a life-threatening emergency;
- determination of the place of hospital admission for patients receiving emergency care based on the place of intervention, the seriousness of pathologies and specialised hospital platforms;
- conditions for assisting the patient from the place of the emergency to the closest healthcare establishment where necessary;
- coordination of means of communication;
- terms for contacting emergency call centres;
- terms for the intervention of any emergency team in response to an emergency call;
- terms for intervention outside of emergency calls, based on the proximity of care structures and the availability of teams
- guarantee of continuity of care, particularly as regards the reception and information provided to patients;
- conditions for access to care;
- healthcare transport;
- terms of release;
- conditions for billing and reimbursement;
- patient information (medical file, clinical summary, release letter, operative report);
- welcome booklet in each respective official language.
- criteria for assessment and inspection of the quality and safety of care:
- quality policy measurement for risk management, notably relating to all areas of vigilance;
- distribution of medicines;
- blood transfusion;
- anaesthesia;
- management of iatrogenic risks and nosocomial infections;
- updating of healthcare professionals' knowledge;
- sharing of patients' medical information;
- pain management.
- method applied to the sharing of good practices ,
- financial means required to implement cooperation,
- procedures for payment, billing and reimbursement of care under the agreement between responsible institutions,
- duration and conditions for renewal and termination of the agreement.
law applicable to the cross-border activities of healthcare professionals and their liabilities:
- applicable law as regards medical liability is that of the State within the territory of which the services were provided,
- French healthcare professionals, establishments and services must necessarily take out civil liability insurance covering any losses that may be caused by their activities during cross-border cooperation,
- the Parties undertake to guarantee compensation to patients having suffered losses, pursuant to their respective legislation,
- the Parties must take all necessary measures to facilitate the crossing of shared borders for implementation of this framework agreement,
- this framework agreement does not prevent the implementation the provisions set out in the International Health Regulation on either side of the border.
conditions of care and reimbursement of care:
- for persons residing or visiting the border area, care and transport costs are covered by the country of care, according to the rates applied by said State, under Regulations (EC) No 883/2004 and (EC) No 987/2009 (after issuance of prior authorisation (S2 form) for visiting persons),
- payment of care by the patient and direct cover by the State of affiliation according to its own rates,
- option for the State of affiliation to directly cover the costs of care based on specific rates negotiated between the signatories of local health cooperation agreements,
- specific provisions for persons legally residing in Spain or in France and to which Community legislation does not apply.
deadline for compliance:
- where necessary, existing cooperation agreements must be brought into compliance with the framework agreement within one year of its entry into force.
terms for assessment of the agreement:
- creation of a joint commission comprised of representatives of both States' competent authorities, which must meet at least once a year or whenever necessary at the request of either Party. This commission is tasked with:
- overseeing the application of the framework agreement and proposing amendments,
- settling any difficulties relating to the application or interpretation of this framework agreement,
- producing a yearly assessment report on implementation of the health cooperation scheme.
