Mr. Paul Barron:

I would like to provide the committee with a brief overview on the application of the directive on the application of patients' rights in cross-Border health care, more generally known as the cross-Border directive. As members will be aware, the vast majority of patients receive health care in their country of residence. However, in certain circumstances, patients may wish to receive their health care in another country, for example, in the case of highly specialised treatment. The new directive seeks to ensure a clear and transparent framework for the provision of cross-border health care within the EU and EEA. In particular, it aims to facilitate access to safe and high-quality cross-border health care; promote co-operation on health care between member states, while fully respecting their national competencies in the field of health; facilitate the reimbursement of the cost of treatment in another member state; introduce a system of prior authorisation for certain categories of treatment; and facilitate efficient transfer of patient information between member states.

The directive gives people who ordinarily reside in Ireland the option to obtain the health care that they are entitled to under our public health system delivered in another EU or EEA country. The health service provider abroad may be in the public or private sector. The costs will be borne by the patient and he or she can seek reimbursement for the service from the HSE upon his or her return to Ireland. Reimbursement will be equal to the cost of the health care abroad or the cost of similar treatment here, whichever is the lesser. Similarly, persons resident in other EU and EEA states may use Irish health services subject to appropriate referral.

On the transposition of the new directive, there will be two alternative routes for patients who wish to receive planned health care in another member state that will be paid for by the member state in which they reside. The first of these is the long-established route under the relevant EU regulations, commonly known as the E112 route.

The second is the new route under the cross-border directive. The main differences between the two routes are the existing E112 route relates only to treatment provided in the public sector; the treatment must not be available in the health system where the health patient lives; the care must be pre-authorised by the home state; and the costs and reimbursement are handled directly between the home member state and the health care provider abroad rather than between the patient and the health care provider.

By contrast, under the directive there is no requirement for the treatment to be unavailable in the health system where the patient lives, and patients may access treatment in either the public or private sector in another member state. However, patients must pay the health care provider directly for the treatment and then seek reimbursement from the home health system up to the cost of similar treatment in the home state or the actual amount paid whichever is the lesser. Except where the member state opts to have certain treatment subject to a system of prior authorisation, and this power is limited under the directive, the patient is not required to obtain prior authorisation.

Under the directive the member state has obligations to its own residents and to residents in other member states. In the case of Irish residents we must ensure the procedures regarding the use of cross-border health care and reimbursement of costs are based on objective non-discriminatory criteria which are necessary and proportionate; that the procedures are easily accessible and freely available publicly; that requests for cross-border health care are dealt with objectively and impartially; that requests are dealt with in a reasonable period of time, taking into account the specific medical conditions, urgency and individual circumstances of the patient; that decisions regarding the use of cross-border health care and reimbursement are properly reasoned, subject to review and open to challenge in judicial proceedings; and where a patient has received cross-border health care that any necessary follow-up medical assistance the patient may require would be the same as had the patient received the care in Ireland. We must also ensure patients who seek to receive or receive cross-border health care have remote access or be granted a copy of their medical records.

Member states have the option to offer patients a voluntary system of prior notification whereby the patient receives written confirmation of the amount to be reimbursed based on an estimate of the costs. This estimate must take into account the patient's clinical case specifying the medical procedures likely to apply. In the case of residents of other member states we must provide information on request about practical aspects of receiving cross-border health care in Ireland. This includes providing information on treatment options, quality and safety, invoices and price information, the applicable fees, and appeal and redress procedures if patients consider their rights have not been respected. Patients must also have access to a copy of their medical records.

Draft statutory provisions to fully implement the directive here have been prepared and are being considered by the Department. They will then be examined by the Office of the Attorney General prior to settling. Our aim is to have the necessary statutory provisions in place before the end of the first quarter of this year. In the meantime a national contact point, NCP, has been established in the HSE. The NCP is a key provision of the directive. Its function is to provide information to patients resident here and those abroad considering coming here for services. The NCP will advise on all aspects of the directive, including the terms and conditions for reimbursement of costs and the procedures for accessing and determining entitlements. The NCP has arranged for information on the directive to be placed on the HSE website. I am pleased to answer any questions members may have.