Cross-border healthcare system function, performance and cooperation in Europe: a scoping review protocol

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.

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-Concept-Context 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.

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.