Cerdanya Hospital: a unique binational health center in Europe

A unique hospital deserves unique surroundings, and this is probably why Cerdanya Hospital is set at the foot of snow-capped mountains, beside farms and villages in the Pyrenees. But Cerdanya's health center is actually much more interesting for how its governed than for where it lies.

It is located just 800 meters from the Spanish-French border, on the outskirts of Puigcerdà, in Cerdanya county. The hospital serves residents in the Gran Cerdanya (Great Cerdanya) area, which is split by the border, and the historical Catalan county of Capcir, on the French side of the border.

"Cerdanya Hospital is a binational entity created to provide healthcare and hospital care to all of the population of what we like to call Gran Cerdanya and in Capcir," Xavier Conill, the managing director of the hospital tells Catalan News.

"It is a public hospital, but its peculiarity is that it is a binational public hospital managed by Catalan and French authorities," he added.

The management of this infrastructure is divided between the Catalan health department and the French health ministry in a 60-40% partnership. This is possible because it is a European Grouping of Territorial Cooperation, a mechanism introduced in 2006 by the European Parliament.

In fact, Cerdanya Hospital was one of the first projects that applied this formula and it even won the Building Europe Across Borders award in 2016, given out by the European Committee of the Regions to the best cross-border cooperation project.

The hospital has a very "useful" heliport, from where visitors can see the mountains on the French side of the border and small villages on the Spanish side. 

This proximity to the border could make patients believe it is a cross-border health center, but Conill prefers another description.

"We have introduced the word 'binational' because we like it more than cross-border because cross-border is still discussing borders, while binational is not," Conill says.

While there are other hospitals in Europe that offer some cross-border services, Cerdanya Hospital is the only one considered binational and managed by administrations from two sides of an international boundary.

  

The late 1990s

Cerdanya Hospital is a reality because three major things happened in the county in the late 1990s, around 1997-98. 

The first was a "snowstorm blocking all roads connecting Cerdanya with Perpignan for many days," Conill says. This "made it complicated for French citizens to reach hospitals in Perpignan and Prades."

Furthermore, French authorities, due to planning purposes, closed down the maternity ward in Prades, prompting pregnant women to travel 160 kilometers on a "very difficult road" to Perpignan to give birth.

Finally, Puigcerdà Hospital, which had been open for centuries, was becoming "small and old," and patients needed newer facilities.

All of these issues drove Catalan president, Jordi Pujol, and president of the French Languedoc-Roussillon region, Jacques Blanc, to meet in February 2003 and agree to study the possibility of opening a new health center.

Construction work eventually started in February 2009. A series of setbacks and delays meant doors did not open until September 19, 2014 at 7am.

Two health services

Cerdanya Hospital is relatively small with 35 beds across 60 rooms, meaning there is still room available as they currently offer double rooms fro each patient.

But even though there are not a lot of rooms, the hospital has "basic services," including surgery, trauma and orthopedics, gynecology, and pediatric services, Conill says.

All these services are open to those registered in the Catalan health service, CatSalut, and those in the French service, Assurance Maladie (Amelie). At the door, there is a small check-in machine that supports both health cards, the Catalan one and the French Carte Vitale.

But not all services are used in the same proportion. For example, "we would treat around the same number of northern residents of the border than southern ones in trauma," Conill says. 

For other services such as a "prosthetic replacement, people living on the Spanish side of the border will come here as it is much more practical than driving to the central city of Manresa," and because the health department will suggest they be treated in Cerdanya. While in France, patients can choose to go to, for example, Paris, if they prefer.

"When we talk about the 60-40 proportion it is because the population proportion is more or less this one," Conill says, as there are more inhabitants in the southern part than in the northern part.

30,000 inhabitants or 180,000 inhabitants

The hospital serves around 30,000 inhabitants, but during peak holiday seasons, it can serve up to 180,000 inhabitants.

During the pandemic lockdowns, police had to ask the hospital for a list of patients who visited the clinic to allow them to cross the border.

But "despite the situation, we were able to react," Conill says.

"Many patients in more serious condition had to be moved to other hospitals, but [because everyone was at home during lockdown] we could treat residents in the area," he adds.

Day-to-day difficulties

Border crossing during the pandemic is just one of the examples of the day-to-day difficulties this unique binational hospital has. Others include management decisions between the French and Catalan health departments, different working practices, or having to install phone antennas because in some corridors, phones connected to French cellphone signal, and in some other areas, phones connected to Spanish cell networks. 

Healthcare workers "try to treat our patients the best way we know, regardless of where they reside. This is our vision. We do have many problems, but we should try to reach unique solutions to unique problems," Conill says.

Paperwork and administrative complications are par for the course at the health center, and it even affects ambulances, as the ones from the Catalan emergency services cannot travel to the northern side of the border, nor can French ones travel south of the border, except to go to the hospital. 

Births and deaths

Challenges appeared from day one when the hospital opened in 2014. Managing births and deaths, especially of patients who live on the French side of the border, is, up to this day, still complicated. 

Currently, a newborn baby is still considered a French citizen born abroad, making it more time-consuming for parents to register their newborn child in the French registry, even though the French health ministry also manages the health center. 

Something which, with time, has changed is the treatment of those patients who pass away. In the past, remains that needed to cross the border had to be moved in lead coffins, making the process more expensive and complicated. 

"Now though, the whole process takes around 24 hours," Conill says. 

Languages

A binational hospital managed by different administrations with different languages is quite unconventional. 

All signs are written in Catalan and French, and Spanish too, as authorities from the Spanish government urged days before the health center opened. As such, there are signs that read: 'RR.HH.,' 'RR.HH.,' and 'RH,' (HR in English), or even 'Administració,' 'Administración,' 'Administration' - this last one should be read in a French accent rather than an English one. 

These signs are to indicate where to go, but what do workers speak to each other and to patients?

Easy, whichever language they understand. And when treating patients in the patient’s mother tongue. 

"Speaking Catalan and French, or Catalan, Spanish, and French… Well, if we found someone that speaks three, four, or five languages, amazing! If not, at least workers should be willing to learn," Xavier Conill says. 

Even all of Hospital Cerdanya’s social media posts are bilingual. 

European experiment

The binational Cerdanya Hospital project opened in 2014. A decade on, the team hopes Europe will consider it an experimental lab to learn more about binational management and how to care for European citizens.

"We ask the European Union to consider us as their experimental lab for management and binational administration, which is very important and especially for services for the European citizen," Conill says.