Written answers

Wednesday, 21 February 2018

Department of Health

Cross-Border Health Initiatives

Photo of Billy KelleherBilly Kelleher (Cork North Central, Fianna Fail)
Link to this: Individually | In context | Oireachtas source

159. To ask the Minister for Health if his attention has been drawn to the fact that the Health Service Executive shall not make the reimbursement of the costs of cross-border healthcare under EU regulations subject to prior authorisation except in circumstances in which it has been made subject to prior authorisation under regulation 12; the exceptions under regulation 12; the date the exceptions were made; the reason for the exceptions, in tabular form; and if he will make a statement on the matter. [8957/18]

Photo of Billy KelleherBilly Kelleher (Cork North Central, Fianna Fail)
Link to this: Individually | In context | Oireachtas source

160. To ask the Minister for Health his views on whether in the ordinary course of requiring medical treatments that the spirit of the cross border EU regulations not to require prior authorisation is being thwarted by the information on the HSE website; and if he will make a statement on the matter. [8958/18]

Photo of Simon HarrisSimon Harris (Wicklow, Fine Gael)
Link to this: Individually | In context | Oireachtas source

I propose to take Questions Nos. 159 and 160 together.

The Cross Border Directive 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 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.

The HSE, as the National Contact Point (NCP) for the Directive has the responsibility to ensure Irish patients who seek to have healthcare abroad under the terms of the Directive are assisted with access to the information they need to make an informed choice. The HSE advises where a patient is in any doubt as to the need to seek prior authorisation before availing of a consultation or treatment abroad to contact the NCP. The NCP will advise patients of the reimbursement rate that will apply to the assessment/treatment being accessed.

Regarding prior authorisation of healthcare, Article 8 of the Directive permits this in certain circumstances and was transposed into Irish law by Regulation 12 of S.I. 2013 of 2014 on 14 July 2014. Regulation 12 lists the circumstances where the HSE may specify particular cross-border healthcare as subject to prior authorisation. These circumstances are as follows:

(a) involves planning requirements relating to the object of ensuring sufficient and permanent access to a balanced range of high quality treatment in the State, or the wish to control costs or avoid, as far as possible, any waste of financial, technical and human resources, and -

(i) involves overnight hospital accommodation of the insured person for at least one night, or

(ii) requires the use of highly specialised and cost-intensive medical infrastructure or medical equipment,

(b) involves treatments presenting a particular risk for a patient, or,

(c) is provided by a healthcare provider that, on a case-by-case basis, could give rise to serious and specific concerns relating to the quality or safety of the care, with the exception of healthcare which is subject to European Union legislation ensuring a minimum level of safety and quality throughout the European Union.

However, the HSE may refuse to grant prior authorisation in the following circumstances:

(a) the patient will, according to a clinical evaluation, be exposed with reasonable certainty to a patient-safety risk that cannot be regarded as acceptable, taking into account the potential benefit for the person of the sought cross-border healthcare;

(b) the general public will be exposed with reasonable certainty to a substantial safety hazard as a result of the cross-border healthcare in question;

(c) the healthcare is to be provided by a healthcare provider that raises serious and specific concerns relating to the respect of standards and guidelines on quality of care and patient safety, including provisions on supervision, whether these standards and guidelines are laid down by laws and regulations or through accreditation systems established by the Member State of treatment; or

(d) the Health Service Executive can provide healthcare that is the same as, or equivalent to, the healthcare sought by the patient within a time limit which is medically justifiable, taking into account the patient’s current state of health at the time the decision under this Regulation is taken and the probable course of the medical condition to which the healthcare relates.

Nevertheless, a patient may, if they wish, request prior authorisation for any procedure regardless of whether or not this is required under Regulation 12. This has the advantage for the patient as they will receive an indication of the level of reimbursement to expect and also an assurance they are complying with any conditions necessary under the terms of the Directive.

As the HSE has responsibility for the administration of the Cross Border Directive I have asked the HSE to examine the issues raised concerning the information on the Cross Border Directive on its website and to reply to the Deputy as soon as possible.

Comments

No comments

Log in or join to post a public comment.