Róisín Shortall (Dublin North West, Social Democrats)
Link to this: Individually | In context | Oireachtas source

273. To ask the Minister for Health if breast reduction surgery on medical grounds and supported by a consultant’s letter is available under the treatment abroad scheme and-or the cross-border healthcare directive; the procedure for a person to access treatment under these schemes; and if he will make a statement on the matter. [29485/18]

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

Patients can seek to access health care in an other EU/EEA member state via two different schemes. Where a service is provided in Ireland but a patient wishes to access care in another EU/EEA Member State, this can be possible by seeking treatment under the Directive on Patients' Rights in Cross Border Healthcare, otherwise known as the Cross Border Directive (CBD).

The CBD provides rules for the reimbursements to 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.  Patients may access the healthcare they require in either the public or private healthcare system of another Member State under the CBD. Access to healthcare abroad is based on patients following public patient pathways, i.e. they must demonstrate they have followed the equivalent public patient pathways that a patient would follow if accessing public healthcare in Ireland. It is important to note that reimbursement is confined to the costs of the care itself and that the rates of reimbursement cannot exceed the cost of provision of the care if it were provided in the Irish public health service.

Certain health services, e.g. services of public health, long term care, organ transplantation, etc. are excluded under the CBD.

The HSE operates the CBD in Ireland. Referral for care under the CBD may be made by a GP, a hospital consultant and certain other clinicians. In line with practice in other EU Member States, the HSE through the National Contact Point (NCP) provides information for patients on the CBD on its website which can be accessed at:

hse.ie/eng/services/list/1/schemes/cbd/and also by phone at 056 7784551. The HSE advises where a patient is in any doubt as to the need to seek prior authorization before availing of a consultation or treatment abroad to contact the NCP.

The HSE also operates the Treatment Abroad Scheme (TAS) for persons entitled to treatment in another EU/EEA Member State or Switzerland under EU Regulation (EC) No. 883/2004, as per the procedures set out in EU Regulations (EC) No. 987/2009. The TAS provides for the cost of approved treatments in another EU/EEA member state or Switzerland through the issue of form E112 (IE) where the treatment is:

- Among the benefits provided for by Irish legislation;

- Not available in Ireland; and

- Not available within the time normally necessary for obtaining it in Ireland, taking account of the patient's current state of health and the probable course of the disease.

GPs refer patients to consultants for acute care and it is the treating consultant who, having exhausted all treatment options including tertiary care within the country, refers the patient abroad under the terms of the TAS. The consultant must specify the specific treatment and in making the referral accepts clinical responsibility in relation to the physician and facility abroad where the patient will attend.

Each application is reviewed individually and a decision is made in accordance with the legislation and guidelines and on the basis of a review by clinical experts. Each application is given a formal written decision and where a decision is one of decline, the reason for that decision is clearly outlined and the option of an appeal is afforded. Previous approvals or declines are not used as an influencing factor on subsequent applications. The appeals process is outlined in each decline letter without exception. Where on appeal a decline decision is upheld, the appeal decision letter advises that the applicant can make a further appeal to the Office of the Ombudsman.  Full details on the scheme can be found on the HSE website at: hse.ie/treatmentabroadscheme.