L'accessibilité transfrontalière aux maternités Enjeux territoriaux d'une coopération sanitaire dans la Grande Région

The links between health/border, where several entry points can be envisaged. (1) via the law whilst centering the analysis on the conditions of concordance between the different healthcare systems. (2) via economics with a comparative study of healthcare costs, and (3) via the notion of space with location-allocation models. This is a territorial planning perspective aimed at gaining a vision for cross-border decision-making. The method used takes account of the existing healthcare network, whilst varying the openness of the borders in terms of harmonisation of healthcare systems.

The article is structured in 3 parts. First of all, there is a reminder of the basics of the approach, where three parameters form the base for a delineation of areas of influence. Two of them concern the estimation of demand and the analysis, starting with the location of maternity hospitals. Access time represents a distance-time constraint in delineating the areas of influence. A 30 minute threshold was set with a view to emergency use. And this parameter rests on the opening or closing of borders, since if they are closed the threshold is 0 whilst if it is the opposite, accessibility is calculated as if the border did not exist. The capacity of the maternity hospital and demand are also taken into account.

The gains in terms of citizens' access to maternity hospitals in the event of health cooperation are demonstrated in the second part, where three parameters are combined: accessibility, supply and demand, which allows areas of influence to be obtained for each maternity hospital that are not strictly limited.  It is here that a comparison is made between a map where harmonisation of social security systems is taken into account and another where the harmonisation is absent.  This reveals that there are three sectors where opening the border would have a beneficial effect for citizens in terms of access to maternity hospitals. The first sector is the extreme south of Wallonia in contact with France and Luxembourg where Arlon maternity hospital is isolated, which constitutes a vulnerability in the event of saturation or even the closure of this facility as the other maternity hospitals in Wallonia are a considerable distance away. The same situation is observed in the French spatial units in the east of Moselle in contact with Saarland. A third sector represents a more interesting situation, that of the north-west of Luxembourg, where a process of competition between Bastogne maternity hospital (Wallonia) and the one in Wiltz (Luxembourg) is observed. The town of Bastogne is attracted by the maternity hospital in Wiltz (which recorded 145 births with 26 beds), whereas the opposite is not true since the Bastogne hospital is undersized (190 births, but only 13 beds).

The feasibility of a health cooperation initiative requires coordination at the administrative, economic and technical, but also cultural level (overall management of the patient, or in stages). Two examples are highlighted. The first is the situation between Saarland and Lorraine, which presents a high level of discontinuity in the healthcare management area. The second is the situation of Saarbrücken and Forbach, where patients can be taken to either hospital depending on the distance to be covered or the saturation of the different wards. It is by resolving problems of an economic, administrative and practical nature that this last example has demonstrated the feasibility of this type of coordination between healthcare systems.