Oireachtas Joint and Select Committees

Monday, 8 March 2021

Seanad Committee on the Withdrawal of the United Kingdom from the European Union

Cross-Border Healthcare Directive: Discussion

Mr. Mark Regan:

I echo what Mr. Quigley said regarding the frenzy we saw many times last October and November when people thought this scheme was going to finish, with people jumping ahead of queues. There was a deluge forward to get this over with, and the stress that went with that. Then, in December, nobody was willing to take the risk and nobody got treatment. I cannot stress enough the urgency of trying to get this into law as soon as possible to ensure stability in the scheme, not leaving it until after the summer and into the autumn to experience that again and the stresses it caused for many of the patients.

With regard to the initial question from Senator Gallagher about what we would do differently or what the shortfall was in this, so far there has been no perceptible difference in the scheme from last year to this year. It has worked largely the same. I worry that while I may have a list, and I alluded to two or three things that would potentially improve it, they also create an element of a barrier to accessing the scheme, which may be morally wrong but, as a societal matter, it is probably better that there are not hundreds of thousands using this and that it is maintained to a degree. That is challenging healthcare to try to get across that it is not being financially driven by access to finance, but making it perfect may well tip the scales whereby the entire thing collapses.

The shortfalls are a problem whereby patients gather the information on what they believe will be a shortfall and get approval from the HSE. When they have the surgery, however, they may find that the shortfall is slightly different. That is due to the coding that is used. Both institutions in the North and the South use different coding systems to describe the surgery. Perhaps there should be a tightening up of that whereby if one gets a pre-authorisation for a given code and that surgery is carried out, then that is locked in after the surgery so the patient does not get a shock when he or she comes out of surgery. That is what we have tried to do for the past five years in Kingsbridge in Belfast in order to make sure that there are no shocks. We want this scheme to be used as it is. It is not a money-making racket or about charging people more. It must be done morally and properly, and we must try to make it a free flow of information throughout.

Finally, the exchange rate also causes a bit of a problem. That is likely to be the case in any event and is outside of our control. Nevertheless, I stress that the scheme has been a massive success for five years. Perhaps changing those ideals will tip it in the wrong direction and leaving well alone may well be the best advice.

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