Caitriona Mullan: 'Interreg should support deeper cooperation between health systems, rather than just funding parallel capital investments on either side of a border'

She also advises the Association of European Border Regions on the EU b-Solutions initiative funded by the DG REGIO border focal point, which addresses and solves cross border obstacles to mobility, integration and EU citizens’ rights across the EU and on EPA borders. We could name many other roles - her professional list is long: expert with the Council of Europe’s Centre of Expertise in Multilevel Governance at the Congress of Local and Regional Authorities, writer of publications and articles, advisor at the Astronomical Observatories of Ireland, and senior research associate with the International Centre for Local and Regional Development, and the Centre for Cross Border Cooperation.

We’ve had the chance to interview Caitriona after an event on cross-border healthcare that she organised alongside the European Commission. 

How did you end up as cross-border healthcare policy & governance specialist? What’s your role in cross-border health care solutions?

I’m actually a specialist in cross-border cooperation and governance more broadly, so I’ll start there. I grew up on the Northern Ireland/Ireland border, in Derry/Londonderry - a city in Northern Ireland bordered on three sides by the Republic of Ireland. Our natural hinterland has always been across the border. One of my parents was from Northern Ireland and the other from the Republic, so I spent my childhood crossing back and forth. Living in a place with layered cultural identities gave me a lasting fascination with the liminality of border regions and the creative space they offer through constant change and fluidity.

I studied at Trinity College Dublin in the early 1990s, and my first job as a history and Irish language graduate was in policy research for the Irish Minister for Social Affairs. This was during Ireland’s EU Presidency, when we facilitated discussions on integrated social protection and labour mobility. The EU Single Market and the “Europe of the Regions” agenda were key influences. For a young graduate, it was an exciting insight into how the European project could work across all borders.

Later, I pursued postgraduate research on the Irish peace process, which had a strong cross-border element. I then worked in local economic and social economy development, tackling issues like housing, energy transition, and long-term unemployment. In the early 2000s, I returned to the border region to work on Interreg programming just after the peace agreement, helping build capacity for cross-border cooperation in a post-conflict context.

After some years in Interreg - and a lot of driving - I had my first child and needed a job closer to home. I moved from regional development to health, beginning with an Interreg project on alcohol, early intervention, and family support. That led to a role in Health Service Transformation, working across programmes of care, developing integrated and community care systems, and addressing clinical governance and patient safety. I found myself drawing on cross-border skills to bring stakeholders together and solve problems across administrative and institutional boundaries. Health systems fascinate me as human-centred ecosystems with a core humanitarian function - and they’re often the most visible part of public services. With international best practices, health care has the potential to transcend borders and serve everyone equally.

Throughout, I stayed personally involved in strategic cross-border and spatial planning research. In 2019, I decided to work independently, bringing together all my experience across central, regional, and local governance. One of my first assignments was coordinating a study for Association of European Border Regions (AEBR) and DG SANTE on cross-border patient mobility in selected EU regions. We conducted the research during lockdown, working remotely with border-region stakeholders responding to the pandemic. It was a profound experience that revealed how health systems function under pressure. Our recommendations are now inspiring post-pandemic developments in border regions. Since then, I’ve supported many b-solutions cases focused on removing obstacles to cross-border health cooperation. There’s a clear and growing need for this work across the EU’s internal and external borders, especially as these issues become priorities for regional and local governments.

When we speak about ‘cross-border cooperation and resilience through the lens of cross-border healthcare collaboration’, what are we talking about? 

In the first sense, we’re talking about cooperation and pooling of assets across borders in ways that organise resources effectively to meet citizens’ health needs, especially those of border populations. This kind of cooperation helps guarantee a basic quality of life. It also recognises that health status is a key driver of social and economic wellbeing, individually, collectively, and territorially. Healthy populations are more competitive. People living in border regions need access to quality care. Investors want to know that health services are in place for their workforce. And there’s strong potential for innovation (in health tech, digitisation, and social innovation) when local systems collaborate across borders. These are the building blocks of thriving, high-functioning border regions.

In a second sense, we’re talking about how border regions (and entire Member State health systems) can maximise their assets by learning from major system shocks like the Covid-19 pandemic. This includes improving standards of care in border areas and recognising the value of cross-border patient catchments, which help clinical specialists maintain and grow their expertise locally. When cross-border health systems function well and tap into the knowledge and capacity of their neighbours, everyone benefits. Member States can strengthen their overall health capacity by supporting shared services models that work across borders. Preparing for future demands —whether driven by demographics, health shocks, or evolving care needs —means developing systems that don’t stop at borders. It also strengthens medicine and medical science by enabling clinicians, researchers, and teaching institutions to collaborate and train across regions. 

Ultimately, this is about building a European Health Union, not just in terms of regulation and disease control, but as a health-promoting union that delivers international best practice across all territories, including the borderlands. Given that 30% of the EU population lives in border regions, this is a strategic issue for bringing Europe closer to its citizens and for achieving balanced territorial competitiveness.

In your experience, what are the key challenges for Interreg programmes when addressing CBC and health-related mobility?

The key challenge for Interreg programmes is to avoid simply plugging funding gaps in national healthcare systems, especially in border regions, which often receive lower levels of Member State investment due to their distance from national population centres.

While modern infrastructure is important - and often rightly needs upgrading in border areas to ensure safe clinical care - this must go hand in hand with seamless, collaborative cross-border capacity to meet population needs. Interreg should support deeper cooperation between health systems, rather than just funding parallel capital investments on either side of a border.

Interreg programmes can also work strategically with Member State Managing Authorities to engage national health policy and decision-makers. The goal should be to ensure Interreg complements, rather than compensates for, national health investment streams; something that will be even more important in the post-2027 programming period.

Another key role for Interreg is to facilitate the development of shared evidence bases and cross-border health data. This can help inform joint planning based on shared capacity and patient catchments —a model that can improve service viability and support innovative shared services and investment. Interreg should be a facilitator not only for local actors, but also for national health systems to engage in cooperative solutions that benefit citizens living in border areas.

When it comes to patient mobility, Interreg programmes should align with EU healthcare legislation that enables not just patient movement, but also clinician collaboration across borders. This includes allowing clinicians to treat, advise, or support care for patients from another jurisdiction, either through mobility or peer-to-peer cooperation near the patient’s place of residence.

Clinicians, not just system managers, need to be involved in designing new cross-border care programmes and patient pathways tailored to specific groups. Patient mobility is only one part of the solution.

Finally, Interreg can act as a soft-space collaboration engine, bringing together healthcare insurers, public and private, to co-develop financing models. These should reduce administrative burdens for patients and make cross-border services and pathways more feasible to operate in practice.

Please, tell us 2 or 3 key findings from the Romania-Hungary programme pilot

I believe the journey that the Romania-Hungary programme is now on is a very exciting one and one which will be seen in the future to have been key in the development of a region of best practice in cross-border health systems cooperation. It’s a region which is rich in knowledge and assets for health --not least because of its medical schools and research institutions such as Szeged University, but also for the medical expertise and desire to improve care for patients post-pandemic that is represented in ordinary hospitals in places like Timisoara, Arad, Oradea, Békès, and Csongrad. 

The region is also pioneering a cross-border population health data platform through the leadership of Békès County Council, and all the local authorities in the Euroregion DKMT are actively involved in driving health cooperation with their health actors. I was to pick key findings from the Romania-Hungary programme pilot, they would be the following:

• Don’t be scared of understanding health as a domain of cross-border cooperation. At the end of the day it’s about better health for the population and using common sense and helping clinicians and health services to deliver to best effect through amplifying the resources available for this, using a cross-border added value approach. Bring clinicians and service users into the conversations where Interreg and Member State health investment priorities for border regions are being determined; develop and support clinicians and future clinicians as key partners to healthcare delivery in border regions through creating opportunities for them to work together across borders as a professional community; listen to patients about their desired experience of healthcare; think about what health outcomes look like for future generations as contrasted to health outcomes of the past.

• Ensure all capital investments in healthcare in border regions are underpinned by collaborative approaches to knowledge, collection and interpretation of population and system data, and the development of human capital as a key capacity within border region health systems; we need to move to a more data-driven culture in allocating resources and determining feasibility of collaboration, and data collaboration is a core building block for this: it allows us to understand ourselves and our regions better.

• Focus on developing integrated care models using the Nine Pillars of Integrated Care - IFIC. This way you know you’re supporting international best clinical practice for evolving population health needs; and within this, focus on specific patient groups such as older people, women and children, multimorbidities, and early intervention and prevention. Think about other actors in border regions and their role in population health and wellbeing, and how they can support this; in particular, think about the role of local government in developing healthy places and building community capacities.

Lastly, could you give us some recommendations for ongoing programmes and projects in the field of health?

I would recommend the following that any cross-border programme or project in the field of health ensures that capital investments are clearly located in a context of what their contribution will be to improving the overall health of a cross-border population; and that provision is made in funding resources for human cooperation between healthcare systems, including shared cross border approaches to skills, education and research.

Also, that programmes and projects have a core objective of creating platforms for the collation and updating of useful territorial data that can inform a joined-up cross-border approach to health systems development: health systems are generally very rich in data, but we need to get better at ways of translating this data into useful information that can inform future service planning and allocation of resources. A good basic population health data evidence base for a cross-border region is the bedrock of all future initiatives and service investment – and can tell us things we don’t know, when we combine data from both sides of the border. 

Finally, I would recommend that programmes and projects maintain a centre of gravity that is about wellbeing of cross-border populations and sharing solutions, and that this learning space is opened not only to regional actors but also to Member State actors where they may not naturally have a chance to focus on CBC in the unique way that border regions can do business across multiple levels of governance. Border regions and their territorial institutions, which are place-based, are the living laboratories for European integration and have a hugely valuable contribution to make to the fabric of Member State economies and to social and economic cohesion at a European level. Healthcare is one of those arenas where this can be demonstrated in a way that makes a real difference to the lives of people now and in the future, fulfilling the human potential of the European project.