Michael McGrath (Cork South Central, Fianna Fail)
Link to this: Individually | In context | Oireachtas source

125. To ask the Minister for Health the amount of money paid by the State in respect of treatment for Irish patients in the National Health Service in the United Kingdom in each year from 2008 to 2014; the amount received by the Health Service Executive for treatment of nationals of the United Kingdom here during the same period; if he expects increased costs for treatment of Irish patients in the United Kingdom following recent changes to the rules in this regard by the National Health Service in that country; and if he will make a statement on the matter. [6249/15]

Leo Varadkar (Dublin West, Fine Gael)
Link to this: Individually | In context | Oireachtas source

Regulation (EC) 883/2004 and Implementing Regulation 987/2009 provide for the coordination of social security systems, including healthcare, within the EU/EEA and Switzerland. Under these provisions, persons who are insured with (covered by) the healthcare system of one EU member state are entitled to receive healthcare in the public system of another member state in certain circumstances, at the cost of the member state in which they are insured. Such persons may include:

-people who are employed in one member state and resident in another and their dependants,

-pensioners of one member state who reside in another and their dependants,

-visitors to one member state from another, and

-persons referred for treatment to another member state.

The EU Regulations provide for the costs to be reimbursed between member states. The Regulations also allow for two or more states to agree alternative arrangements for reimbursement other than those laid down in the Regulations, or to mutually waive reimbursement altogether.

Ireland's primary interaction has been and continues to be with the United Kingdom with whom it operates a bilateral healthcare reimbursement agreement, covering such persons as temporary visitors between the two countries, pensioners of one country and their dependants residing in the other country, and the dependant families of persons employed in the other country. Under the terms of the agreement net liability between the two countries is calculated on a lump sum basis rather than an individual basis. The amount payable is the net difference between the costs to the Irish health services of providing care to those with only UK entitlements and the cost to the UK health services of providing services to those with only Irish entitlements. The amount payable is agreed following compilation of the necessary data and discussions between the two administrations. Payments are made in advance and are subject to final settlement once all necessary statistical and financial information is complete. Total payments in any one year can as a consequence relate to both final settlements in respect of previous years' liabilities and advance payments in respect of the current and/or previous years. The net payment received by Ireland from the United Kingdom was €100m in 2008; €286m in 2009, €320m in 2010; €270m in 2011; €220m in 2012; €220m in 2013 and €172m in 2014. These amounts represent the actual payments made in cash in these years and do not correspond to the full liability for that particular year.

As explained below, only a small portion of the above payments relates to UK visitors to Ireland and Irish visitors to the UK. By far the largest part of the payment received from the UK authorities on an annual basis relates to the provision of healthcare to UK pensioners and their dependants residing in Ireland. Entirely separate arrangements apply to patient referrals for scheduled treatment in the other jurisdiction whereby the costs arising are reimbursed on an actual costs basis. These arrangements are administered by the Health Service Executive.

The amount payable in any one year attributable to temporary visitors between Ireland and the UK (i.e. EHIC type costs) is determined by the estimated number of visitor days and an estimate of the average cost of providing healthcare treatment. The finalisation of accounts is normally some years in arrears to facilitate collation of relevant statistics and for the approval of the average cost prepared by each country for the year concerned at EU level. The last accounts finalised were in respect of the year 2008 in respect of which Ireland’s liability to the United Kingdom was calculated at Stg£10,161,467 (€12,269,340 approximately) for 22,945,700 visitor days (Ireland to UK) and the United Kingdom’s liability to Ireland was €17,735,993 for 19,095,600 visitor days (UK to Ireland). Accounts for subsequent years have not yet been finalised. However visitor days for the years 2009, 2010, 2011, 2012 and 2013 have been estimated respectively as follows:

Estimated Visitor Days in 000's