Brendan Smith (Cavan-Monaghan, Fianna Fail)
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447. To ask the Minister for Health his plans to improve access to the HSE cross-border directive under which patients accepted onto the scheme who cannot afford the cost of surgery up-front are ineligible for treatment (details supplied); and if he will make a statement on the matter. [53914/17]

Simon Harris (Wicklow, Fine Gael)
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Under the conditions of EU membership, all Member States must implement EU Directives. Consequently under the EU Directive on Patients’ Rights in Cross Border Healthcare each Member State is required to implement the Directive's provisions regarding access to healthcare in other Member States/EEA countries.

The Directive on Patients' Rights in Cross Border Healthcare provides rules for the reimbursement of patients' of the cost of receiving treatment abroad, where the patient would be entitled to such treatment in their home Member State (Member State of Affiliation) and supplements the rights that patients already have at EU level through the legislation on the coordination of social security schemes (Regulation 883/04).

The Directive seeks to ensure a clear and transparent framework for the provision of cross-border healthcare within the EU, for those occasions where the care patients seek is provided in another Member State rather than in their home country. S.I. 203 of 2014 provides the legal basis for the Health Service Executive to operate the EU Directive on Patients' Rights in Cross Border Healthcare in Ireland.

In transposing the terms of EU Directive 2011/24/EU the Irish State, in line with other Member States of the EU, put in place a reimbursement scheme for the costs of cross-border healthcare. This decision reflects the situation that under the terms of the Directive it is the patient who makes the choice to receive their treatment outside of the State. The patient decides the Member State they wish to go to, and the particular institution, or individual, from whom they receive the treatment (which may be in the public or private sector). Given the choice the patient has of such a large and diverse range of providers across the EU\EEA, and their differing payment systems, it is not possible to set up a direct payment scheme. There are no plans to amend this provision of the transposition.