The HSE is to allocate €1 million this year to pay for treatment carried out abroad under new EU rules.

Under the cross-border healthcare directive, which was fully transposed into Irish law in February, any public patient in Ireland with a referral letter from their GP or consultant may obtain treatment in another member state and claim reimbursement from the HSE.

The new directive allows public patients to access treatment in either a public or private setting outside of the jurisdiction and have the HSE pay the bill, as long as the cost is not higher than that which would be incurred in Ireland for a similar procedure.

The scheme is not limited to patients on waiting lists and covers most areas of healthcare, including acute hospital procedures, dental care, speech and language therapy, as well as physiotherapy, disability and mental health services.

Long-stay care, such as nursing home care, is exempt, as are organ transplants.

Reimburse

The HSE said this weekend it would be setting aside €1 million to reimburse the cost of procedures abroad this year.

The Irish Times reported last week that senior HSE managers had expressed alarm that the directive could have major cost implications. Internal records released to The Irish Times described it as a "high-level risk" for the HSE, with significant implications for the health budget.

“There are implications for the health services who have committed to a level of activity in their service plan and who may be required to pay for out-of-State provision,” states one HSE document prepared for the 2015 estimates.

The Sunday Business Post reported that Fine Gael MEP Brian Hayes had expressed concern at the failure of health authorities to publicise patients' entitlements under the directive. He said the HSE had a responsibility to alert patients to their enhanced rights under the new rules.

Minster for Health Leo Varadkar said at the weekend the new scheme was still in its infancy and although €1 million had been allocated for 2015, there was no budget cap.

Pay upfront

“It is not a panacea. Patients need to secure a referral from their doctor in Ireland and someone to accept it overseas, and they also have to pay upfront for the cost of treatment, and then apply to receive the money back. Travel and accommodation costs are not covered and anything that involves an overnight has to be pre-approved.” The Minister said that while the new arrangement would represent a viable option for some cases with delays, he did not anticipate huge numbers of patients availing of it.

However, Mr Varadkar said in the medium term, the new arrangements would make it easier to make the case for increased health spending, as it makes more sense to pay for Irish treatments rather than paying for it in other jurisdictions. He added: “It also fits in well with the implementation of activity-based funding in the public health service, in which money follows the patient, and the move to a commissioning model with a purchaser-provider split.”