1. Claus Toftgaard German-Danish meeting 28.Febr. 2007 Cross Border Mobility South Danish Region-Region Schleswig/Kiel Claus Toftgaard, M.D., MPM Chief Medical Officer South Danish Region

2. Claus Toftgaard German-Danish meeting 28.Febr. 2007 Cross Border Cooperation Radiotherapy in Flensburg since 1999 –County of South Jutland (2006: 200 patients) –Breast cancer –From 2001 New Accelerator (Danish financed) From 2004 waiting time guarantee for the Region From 2007 –Breast cancer and Prostatic cancer for the Region (2007: 400 patients) –Chemotherapy in cooperation with Sønderborg Hospital

3. Claus Toftgaard German-Danish meeting 28.Febr. 2007 Cross Border Cooperation Minor surgery in Flensburg and Nieböll –Waiting time guarantee Delivery in Nieböll –Limited area in DK Helicopter in Nieböll Flensburg Feuerwehr/Nieböll ambulance Emergency treatment Flensburg/Nieböll

4. Claus Toftgaard German-Danish meeting 28.Febr. 2007 Cross Broder Cooperation From 2007 Radiotherapy in Kiel/Lübeck Research Odense – Kiel University Hosp. Meeting between doctors from the two Regions Political meetings Citti’s project and other Interreg projects

5. Claus Toftgaard German-Danish meeting 28.Febr. 2007 Cooperation University Hospitals Since October 2005 meetings between Hospital Directors Priority 1: Research (R&D) Priority 2: Education Priority 3: Treatment Priority 4: Knowledge about leadership and organisation Priority 5: Exchange of employees

6. Claus Toftgaard German-Danish meeting 28.Febr. 2007 Contract about Proton therapy /partikel therapy, European Study Center for Proton/Heavy Ion Therapy Cancer Stemcells Osteoporose Metabolic skeleton diseases

7. Claus Toftgaard German-Danish meeting 28.Febr. 2007 Contract continued Diseases of the Thyroid Diabetes Paediatrics Operativ gynaekology Clinical psycology

8. Claus Toftgaard German-Danish meeting 28.Febr. 2007 Why ? - DK Lack of capacity in DK –Difficulty in recuiting specialists –Working hours regulation –Very tight investment in e.g. accellerators Waiting time guarantee in DK –Little or no incitement for extra activity –Long distance to treatment –(Familiarity)

9. Claus Toftgaard German-Danish meeting 28.Febr. 2007 Why ? - DE Free capacity –Over-capacity –Private organisations (no central steering) Basis for survival Basis for improvement (e.g. helicopter) Professional development (Familiarity)

10. Claus Toftgaard German-Danish meeting 28.Febr. 2007 Strengths Locally initiated Distance Mutual interests Lack in DK versus capacity in DE Familiarity Incorporating professionals in local / national professional Associations Economy

11. Claus Toftgaard German-Danish meeting 28.Febr. 2007 Weaknesses (challenges) No national support (maybe on the contrary) Little EU interest Different professional and political goals over the Region – both side of the border Some differences in structure (e.g. medication in/out of hospital, inpatient versus ambualtory treatment) Tradition

12. Claus Toftgaard German-Danish meeting 28.Febr. 2007 Criteria for a Success Willingness to adopt other national standards (Flensburg/Kiel) Language Professional incorporation Mutual interest Political support / lead (also National level) Data completeness – complete information of all involved professionels (e.g. GP’s, primary health care)

13. Claus Toftgaard German-Danish meeting 28.Febr. 2007 Criteria for a Success Acceptance in National Health systems –DRG –National registers –National health plans –National assurance systems Open for cross border legislation (patient records, responsibility Cross border movement of professionals

14. Claus Toftgaard German-Danish meeting 28.Febr. 2007 What could be the future ? A real cross border cancer center Part of the national / regional Health plan Cross border education of professionals Cross broder employment Cross border professional societies

15. Claus Toftgaard German-Danish meeting 28.Febr. 2007 And what could facilitate ? EU (investment) support (PET/CT, other heavy investments) National health plans Local understanding that it is not competition but development/survival E-health records and images Health data net Shared databases