ZOAST

Between 2008 and 2015, seven cross-border health zones were established along the French-Belgian border, within which patients can access healthcare services on the other side of the border without administrative or financial barriers.
The zones covering the entire border area were established under the INTERREG program. The cooperation is based on an agreement signed by the health ministers of the two countries on June 1, 2005, which authorizes regional authorities to plan, develop, and finance a cross-border joint healthcare system.
Patients can access cross-border care through their own (domestic) social security system, so there was no need to amend European (social security) legislation. To make things easier for patients and reduce the administrative burden, they don’t have to notify their insurer about care they get across the border. The card reader system installed in Belgian institutions is also capable of reading French social security cards, thus ensuring that French patients are registered in the Belgian social security system. The costs are invoiced to the Belgian social security institution. Under the European Union Regulation on the coordination of social security systems (883/2004), the Belgian authorities recover the amount paid to the Belgian hospital from the French liaison body.
The costs incurred are charged according to the tariff of the country of the institution providing the care, thus exempting the patient from paying the fees in advance. A further procedure has been developed for the reimbursement of the remaining costs (co-payment), based on a payment mechanism involving a third party. This reimbursement procedure required software development work.
Thanks to the intergovernmental agreement, 20,000 patients received care in one of the nine health zones in 2015.