Catherine Murphy (Kildare North, Social Democrats)
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39. To ask the Minister for Health his Department's assessment of the effectiveness of the State's adherence to Directive 2011/24/EU on patients' rights in cross-border health care; if he will confirm that it is possible for general practitioners to refer patients to a hospital abroad within the European Union and European Economic Area for a refundable clinical assessment to determine the medical necessity of a procedure covered under the treatment abroad scheme; if he is aware that this option is not readily communicated to patients, who may require urgent clinical assessment; if he will provide statistics relating to the number of procedures carried out in 2013, 2014 and in 2015 to date under the treatment abroad scheme; the associated cost; the number of refunds issued in respect of clinical assessments carried out overseas following Irish general practitioner referral in each of these years; and if he will make a statement on the matter. [36654/15]

Leo Varadkar (Dublin West, Fine Gael)
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The Health Service Executive operates the EU Directive 2011/24/EU on Patients' Rights in Cross Border Healthcare in Ireland, known as the Cross Border Healthcare Directive (CBD). Additionally, the HSE operates the Treatment Abroad Scheme (TAS) under the provisions of (EC) Regulation No 883/2004 on the coordination of social security systems. The TAS and the CBD are distinct schemes. The rules that apply under the Directive and the Regulation are not interchangeable. However, the HSE automatically informs patients of their rights under the Regulation if they have applied under the Directive and vise versa.

The CBD operates as per the public referral pathways in Ireland and, in line with this, a referral by a GP to a consultant abroad is permissible under the CBD. In general, the CBD allows a public patient to access care in another EU/EEA country in either a public or private setting. The healthcare must be healthcare which is available and funded in the public healthcare system in Ireland. Applications under the CBD are not subject to independent medical assessment or with a necessity to demonstrate undue delay. Prior approval is not always required.

The measures employed by the HSE ensure Irish patients who seek to have healthcare abroad under the terms of the CBD are assisted with access to the information they need to make an informed choice, and following any episode of healthcare abroad in line with the CBD, they are promptly reimbursed for the cost of the healthcare upon return to Ireland. I am satisfied that the HSE's CBD application procedures are proportionate and that the prior authorisation process provides patients seeking hospital care which requires overnight accommodation with an assurance on the level of reimbursement they will receive.

All applications to the TAS are subject to prior authorisation and independent medical assessment. In general, the TAS allows for a public patient in Ireland to be referred, to the public health system of another EU/EEA country or Switzerland, for a treatment which is not available in Ireland. Referral for an assessment with a view to a treatment under the TAS may only be made by a treating Irish based consultant, who is in best position to know as to the availability, or otherwise, of the necessary treatment in Ireland. Any application to the TAS for treatment which is available in Ireland but for which the applicant is claiming undue delay is subject to the referring consultant demonstrating how the individual case meets TAS guidelines on the provisions of the European Court of Justice rulings.

The HSE Treatment Abroad Scheme issues Form E112 (IE) for specific episodes of care which an approved patient receives in a public hospital in the EU, EEA or Switzerland. The payment mechanism for these episodes of care are directly between public health systems by way of EU/EEA Model Form E125. These forms/invoices are received in arrears, often up to 2 years in arrears. Therefore the figures detailed in the following table are the current costs as known and are liable to change as invoices for previous years are received and paid, and should be read in that context.

Information on the number of refunds issued, under the Cross Border Healthcare Directive, in respect of clinical assessments carried out overseas following Irish GP referral is not gathered in that format. However, I can confirm that 17 patients were issued with refunds for consultations outside the State following referral from a GP.