{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T12:29:33Z","timestamp":1787056173724,"version":"build-2736575974"},"reference-count":16,"publisher":"BMJ","issue":"8","license":[{"start":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T00:00:00Z","timestamp":1787011200000},"content-version":"unspecified","delay-in-days":17,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Interreg VI-A programme Germany-Netherlands","award":["31177"],"award-info":[{"award-number":["31177"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2026,7,31]]},"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Cross-border collaboration in healthcare has become increasingly important in the context of European integration, particularly in border regions where institutional and health system interactions are most pronounced. These regions offer opportunities for joint healthcare provision, patient and workforce mobility and shared use of resources. However, healthcare governance largely remains a national responsibility, introducing administrative, legal and institutional barriers to coordinated care. This review will examine the structures and mechanisms in place for cooperation and will map the available evidence relevant to the functions of cross-border healthcare in Europe using the Health System Performance Assessment framework.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and analysis<\/jats:title>\n                    <jats:p>This scoping review will follow the Joanna Briggs Institute methodology and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. Eligibility will be determined using the Population\u2013Concept\u2013Context approach. A three-step search strategy will include an initial limited search, comprehensive searches across six databases (PubMed, Web of Science, Medline, Embase, Global Health, Scopus) and grey literature searching. Two reviewers will independently screen studies via Covidence. Data will be extracted using a standardised form and synthesised descriptively. AI tools can assist with specific steps in the Responsible AI in Evidence Synthesis framework, provided they are supplemented by manual verification.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Ethics and dissemination<\/jats:title>\n                    <jats:p>Ethical approval is not required as this review uses publicly available literature. Findings will be disseminated through an open-access publication, conferences and policy briefs targeting cross-border healthcare stakeholders.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2026-117613","type":"journal-article","created":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T11:50:41Z","timestamp":1787053841000},"page":"e117613","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Cross-border healthcare system function, performance and cooperation in Europe: a scoping review protocol"],"prefix":"10.1136","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-2444-8397","authenticated-orcid":false,"given":"Ren\u00e9","family":"Puhlemann","sequence":"first","affiliation":[{"name":"Department of Health Services Research, School of Medicine and Health Sciences, Carl von Ossietzky Universit\u00e4t Oldenburg, Oldenburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ashika D","family":"Maharaj","sequence":"additional","affiliation":[{"name":"Department of Economics, Econometrics, and Finance, Faculty of Economics and Business, University of Groningen, Groningen, The Netherlands"},{"name":"European Observatory on Health Systems and Policies, WHO European Centre for Health Policy, Brussels, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"Homann","sequence":"additional","affiliation":[{"name":"Department of Health Services Research, School of Medicine and Health Sciences, Carl von Ossietzky Universit\u00e4t Oldenburg, Oldenburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adriana","family":"P\u00e9rez Fortis","sequence":"additional","affiliation":[{"name":"Aletta Jacobs School of Public Health, University of Groningen, Groningen, Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dheepa","family":"Rajan","sequence":"additional","affiliation":[{"name":"European Observatory on Health Systems and Policies, WHO European Centre for Health Policy, Brussels, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jochen O","family":"Mierau","sequence":"additional","affiliation":[{"name":"Faculty of Medical Sciences, University of Groningen, Groningen, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefan","family":"Pichler","sequence":"additional","affiliation":[{"name":"Department of Economics, Econometrics, and Finance, Faculty of Economics and Business, University of Groningen, Groningen, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0935-6989","authenticated-orcid":false,"given":"Lars","family":"Schwettmann","sequence":"additional","affiliation":[{"name":"Department of Health Services Research, School of Medicine and Health Sciences, Carl von Ossietzky Universit\u00e4t Oldenburg, Oldenburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,8,18]]},"reference":[{"key":"2026081804501895000_16.8.e117613.1","doi-asserted-by":"crossref","first-page":"753","DOI":"10.1080\/07036337.2024.2418293","article-title":"No fences, good neighbors: measuring and explaining integration in European cross-border regions","volume":"47","author":"Setti","year":"2025","journal-title":"J Eur Integr"},{"key":"2026081804501895000_16.8.e117613.2","unstructured":"European Commission. Statistical Office of the European Union . Regions in the european union: nomenclature of territorial units for statistics (NUTS): 2024 edition. Luxembourg Publications Office of the European Union; 2018. Available: https:\/\/doi.org\/10.2785\/930137"},{"key":"2026081804501895000_16.8.e117613.3","first-page":"1","article-title":"Directive 2011\/24\/EU of the European Parliament and of the Council on the application of patients\u2019 rights in cross-border healthcare","volume":"L132","year":"2011","journal-title":"Off J Eur Union"},{"key":"2026081804501895000_16.8.e117613.4","doi-asserted-by":"publisher","DOI":"10.1080\/00343409950078648"},{"key":"2026081804501895000_16.8.e117613.5","unstructured":"Busse R , Worz M , Foubister T , et al . Mapping health services access: national and cross-border issues (healthaccess): final report. European Health Management Association; 2007. 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Health System Performance Assessment: A Framework for Policy Analysis. Copenhagen: World Health Organization, European Observatory on Health Systems and Policies, 2022."},{"key":"2026081804501895000_16.8.e117613.11","doi-asserted-by":"crossref","unstructured":"OECD . Rethinking health system performance assessment: a renewed framework. In: OECD Health Policy Studies. Paris: OECD Publishing, 2024. 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