According to a European study from 2018, the Netherlands and Belgium have relatively few paediatric surgery centres in comparison with other European countries such as Germany. There are a number of large paediatric surgery centres in different parts of the Netherlands, but no such facility in the south of the country. This means that sick children in the Euregion often have to travel far away from their home and their family to receive treatment. To provide better care in the border region, the Maastricht UMC+ wants to join forces with Uniklinik RWTH Aachen and the Centre Hospitalier Chrétien in Liège to set up a Euregional Centre for Paediatric Surgery.

Cross-border recognition
“When it comes to cross-border cooperation in healthcare, there’s a lot of legislation and regulation to deal with”, says Lavinia Kortese, a PhD candidate at ITEM and principal investigator in this project. “Questions include the recognition of paediatric surgery as a medical specialty, the registration of surgeons in the Meuse–Rhine Euregion and opportunities for cross-border training in paediatric surgery. An obvious and crucial aspect of the future centre is how to ensure that paediatric surgeons can practice in all three countries.”

Paediatric surgery versus general surgery
The ITEM study shows that paediatric surgery is not uniformly recognised as an independent specialty: in the Netherlands it is part of general surgery, while Germany sees it as a separate specialty. Training courses differ fundamentally, which means, among other things, that Dutch and Belgian surgeons cannot directly receive recognition as paediatric surgeons in Germany. In order to register as such, they have to do additional exams or internships. Conversely, German paediatric surgeons cannot register as such in the Netherlands and Belgium because it is not an independent specialty, but part of general surgery. And registering as a general surgeon is not possible without doing additional exams and internships.

Towards an overarching system
“Within the existing frameworks, it is not possible to be trained according to the standards of all three countries at the same time. A decision will have to be made in favour of the system of one of the countries”, Kortese explains. “Depending on which system it is, medical graduates will still have to do internships and exams to have their qualifications recognised in the other countries.”

Legal tools
Differences in qualifications notwithstanding, in other areas there are tools available that facilitate cross-border cooperation. These include the proposed European cross-border mechanism, the European Grouping of Territorial Cooperation (EGTS), and the Benelux Grouping of Territorial Cooperation, an administrative arrangement or joint body for cross-border or inter-territorial cooperation. The use of such instruments simplifies transnational, cross-border and interregional cooperation between Member States or their decentralised authorities, for example by permitting regional governments to establish their own legal personality. The EGTS allows regions to unite without the intervention of national parliaments.

Further research by student team
Founding a future-proof centre means resolving many other potential obstacles, such as the mobility of patients and the financing and optimisation of care. To address these obstacles, ITEM and MUMC+ are continuing their collaboration: in the coming period a multidisciplinary team of six ambitious students from Maastricht University will consider the various issues confronting the Euregional Centre for Paediatric Surgery. The project, part of the PREMIUM honours programme for excellent students, will run until May 2019.

Read the full report ‘Setting up a tri-Member State paediatric surgery centre in the Netherlands, Germany and Belgium: The cross-border mobility of paediatric surgeons in the Meuse-Rhine Euregion’.

The study was conducted by the Institute for Transnational and Euregional cross-border cooperation and Mobility (ITEM).

Read also this article on the website of the MUMC+.