HomeSeptember 2015Patients going to Europe for free treatment

Patients going to Europe for free treatment

Hundreds of Irish people are expected to go to Europe for treatment in public and private hospitals this year under the new Cross Border Directive, (CBD) which provides for the first time that the State will pay for treatments which are already available in this country. Maureen Browne reports.

Maureen Browne
Maureen Browne

And it is expected, that with growing awareness of the new Directive, these numbers will swell to thousands next year.

The new Cross Border Directive provides that a patient can avail of treatment in another EU/dA country and claim reimbursement from the State to the maximum value that the treatment would have cost in the public health system in Ireland. It is the first Directive which allows patients access care in both public and private facilities abroad.

It covers all treatments which are not contrary to Irish legislation, including transplants and long term nursing care, and patients do not need to be on waiting lists to avail of it.

It covers all treatments which are not contrary to Irish legislation, including transplants and long term nursing care, and patients do not need to be on waiting lists to avail of it.

The costs must be borne by the individual and he/she then seeks reimbursement for the cost of the healthcare upon return to Ireland.

The CBD covers both in-patient and outpatient treatment. While it was introduced in June of last year people are only beginning to avail of it and it is expected that as patients become more aware of it thousands of people on long Irish waiting lists will choose to go abroad for their treatment.

The HSE says that if an Irish patient wishes to go to another EU/EEA country for treatment that is available from the HSE or from a HSE funded facility he/she must follow public patient pathways. I understand this to mean that they will only be reimbursed for what it would have cost them to have the treatment in a public hospital here.

While patients do not need to be on a waiting list to avail of the CBD, those who are currently on an outpatient or inpatient waiting list may use the letter confirming this as evidence of medical necessity for the purposes of access to care under the CBD.

However, the HSE says it will not be responsible for the choice of consultant or hospital abroad and strongly urges that these decisions should be made with a relevant doctor in Ireland, ideally, the patient’s G.P..  “This is to ensure the doctor and facility abroad are appropriate to the patient’s needs.”

In general, if a patient’s G.P. decides that referral to another service is warranted, the G.P. will draft and issue a referral letter. The referral letter will be addressed to a consultant and hospital abroad.

The patient’s G.P. identifies the consultant and facility abroad that he or she should attend.

The HSE said that over the past number of months awareness of the provisions of the CBD had been growing substantially.

The patient may attend an outpatient consultation abroad without prior authorisation from the HSE and claim recoupment of the consultation to a maximum value of €130.

If the consultant abroad says that the patient requires inpatient treatment, the patient can download a prior authorisation application form and complete it, in conjunction with the consultant abroad.  The consultant abroad will identify the relevant DRG code (a ready reckoner is helpfully available on the HSE website) for the proposed procedure so the patient will know the maximum reimbursement rate he or she will be entitled to.

The application form is then submitted to the National Contact Point (NCP) of the HSE in Dr. Steevens’ Hospital, which will issue a decision.

The patient can avail of his or her treatment abroad and at the end of the treatment he or she and their consultant can download the pro-forma invoices published on the HSE website and complete it.  The pro-forma invoice along with various other documentation including, but not limited to, proof of travel, hospital invoice, receipt of payment, etc are submitted to the NCP and processed for payment.

Asked how long it takes to recoup money from the HSE, a spokesperson said that upon receipt of the necessary paperwork the NCP processed all requests for reimbursement without delay.

The HSE says that it is difficult to state how many people have availed of treatment under the new Directive. They said that between January and July 2015, inclusive they received 80 completed pro-forma invoices seeking reimbursement and over 400 applications for prior authorisation, but it had to be borne in mind that people availing of OPD treatments/consultations did not need to submit applications for prior authorisation.

Countries where Irish people went for outpatient treatment were Belgium, Czech Republic, France, Germany, Latvia, Lithuania, Poland, Slovakia and the UK.

Those who went for inpatient treatment went to Belgium, Czech Republic, France, Germany, Hungary, Italy, Latvia, Lithuania, Poland, Romania, Spain and the UK.

The categories of treatment being availed of most commonly under the CBD are orthopaedics (hip and knee replacement), general surgery, psychiatry and orthodontics.

The HSE said that over the past number of months awareness of the provisions of the CBD had been growing substantially and this was reflected in the activity in the NCP.

The following are the overall Activity Levels at present available from the HSE:


Description Queries Applications Issued Applications Received Pro-Form Invoice Request Pro-Forma Invoices Received Total Activity
01 June to31 December 2014 94 30 30 22 19 195
01 January to14 May 2015 648 78 32 153 26 937
This represents a 380% increase in activity between the first 7 months of operation in 2014 versus the first 4½ months in 2015.


People from EI/ EEA countries can, of course, also come to Ireland for treatment.

In general they would seek to access the care in the private sector – those seeking to access it in the public sector would be subject to waiting times as if they were a public patient in Ireland.

Since there is no obligation on the private sector to notify the HSE of overseas patients treated in their hospitals, the HSE does not have definitive information on numbers. However a spokesperson said that, while at the moment it was not possible to confirm the number of people who travelled to Ireland to avail of services under the CBD, they were seeking to confirm this information from various sources.