The effectiveness of tailor made care: the example of cross border care between Belgium and the Netherlands

The provision of tailor made care, the search for cost containment and European harmonisation and unification have stimulated insurers, providers, patients and governments throughout Europe to seek for opportunities to establish new health care markets. The opening up of cross border care markets presents a good example. These markets offer health care services and products to patients in other countries than the nation which covers their residency or insurance.
Although there are clear economic motives for cross border care, the number of patients which actually (can) cross borders is relatively limited: practice proves that current institutional frameworks can block patient flows. This raises the question how and which institutional frameworks have to be present or (re)designed in order to develop and establish an effectively functioning cross border health care market.
This paper analyses this question in order to derive lessons and recommendations for future European harmonisation with regard to health care. Using a theoretical framework, which displays the economic motives, obstacles and possible institutional alternatives for cross border care, the conditions for the development and establishment of an effectively functioning health care market between the Netherlands and Belgium is explored. Using cross border care for rheumatological patients as a point of reference, it is shown that current regulations can hinder patients as well as care givers to engage in cross border care. On the basis of our framework, the consumption of Belgians consuming cross border care in the Netherlands is expected to be higher in comparison to the number of Dutch patients who consume care in Belgium. Conflicting interests among private and public specialists, general and academic hospitals, insurance companies and national government policies are also important stumbling blocks for cross border care. Our analysis shows that the most effective institutional frameworks include those that have a functional regional design: they offer the best opportunity to minimize on transaction costs and maximize the degree of tailor made care.