Braunau–Simbach hospital collaboration (Austria–Germany) 45
€2.7 billion by 2020. The reform aimed to save €336 million per year. The plans included a cutback of around 700 beds in all regional hospitals, and several Upper Austrian hospitals would have either to close or to merge wards; some of these would also become day clinics (Meinhart, 2011). KH Braunau had to transform its urology and ophthalmology wards into day clinics and reduce the 419 beds in the remaining wards by 33 (Land Oberösterreich, 2011b). By the end of 2011, KH Braunau also had to close the jointly founded COR GmbH, despite its previous investment in the organization. Pressure for reform from the regional authorities left no latitude for individual hospitals’ attempts at cross-border cooperation and the Braunau–Simbach collaboration was terminated. While in 2006 Upper Austrian authorities had proudly announced the collaboration’s incorporation into regional hospital planning (Landeskorrespondenz, 2006), in 2011 they claimed that the joint coronary angiography unit would conflict with “precise planning of regional hospital provision” (Landeskorrespondenz, 2011), and a spokesperson stated that “an Upper Austrian hospital should mainly serve patients from its own country” (MeinBezirk.at, 2011). Local politicians and stakeholders involved in the hospitals tried to challenge the reforms, even collecting signatures from Bavarian citizens for a petition in support of KH Braunau, but these efforts failed (UNS, 2011). A petition against the reform from the citizens of Braunau also collected 53 000 signatures, but did not change the authorities’ decision (OÖNachrichten, 2011). Role of the EU
The Austrian and German health care providers tried to eliminate or solve the problems they encountered using two strategies. The first was at the (bi-) national level described above, but given the inherent limitations of trying to gain national support, the collaboration partners also turned to the European level to intensify their cooperation, trying to make use of resources provided by the EU. These strategies were closely linked, and both partners played the “Europe card” to legitimize their efforts in talks with their respective national administrations. The Austrian discussions about regulating a European crossborder project show that cooperation is not only dependent on regional political support but also closely linked to other interests at the national level. The freedoms provided by the EU’s common market, however, are not always perceived as an advantage; they can also be interpreted as a threat. To access the investment necessary to guarantee barrier-free access for patients at both hospitals, the partners applied to the European Structural Fund. The project received roughly €200 000, which was used to set up a scheme for regular