Huge increase in patients going outside Ireland for treatment
Thousands beat waiting lists by using EU scheme to go abroad for treatment and the HSE foots the bill, writes Priscilla Lynch
Irish patients fed up of long hospital waiting lists are increasingly heading abroad for treatment - with the HSE picking up the bill.
The EU cross-border healthcare directive allows patients to access operations, specialised inpatient care and outpatient appointments in another European country once they have a referral letter from a GP or hospital doctor in their home country, and then have their costs reimbursed by their home health service.
Use of the directive by Irish patients is soaring as HSE hospital waiting lists have hit record levels. The latest National Treatment Purchase Fund (NTPF) waiting list figures show that 507, 507 people were awaiting an outpatient appointment, while 79,414 were awaiting an inpatient/day case procedure, at the end of April.
To date, the HSE has reimbursed 4,615 procedures/appointments for Irish patients at a cost of €9.247m since the directive came into force in Ireland in October 2014.
While use of the directive was slow initially, with only 150 claims at a cost of just over €500,000 in 2015, the HSE reimbursed 1,025 claims under the directive in 2016 at a cost of €1.447m. In 2017, HSE costs under the directive rose to €4.4m for 2,011 reimbursements.
And claims under the directive for the first four months of this year are already up hugely on 2017, with 1,422 reimbursements at a cost of €2.79m to date in 2018.
While claims under the directive are for many different types of procedures and treatments including joint replacements and tonsil removals, cataract surgery is proving particularly popular this year.
A recent survey by the Association of Optometrists Ireland (AOI) revealed that waiting times for cataract surgery are up to five years in some parts of the country.
For the first four months of 2018, the HSE has reimbursed 415 outpatient appointments and day case procedures for cataract surgery abroad, at a cost of €314,811. This compares to a total of 162 such reimbursements, at a cost of €130,620, under the directive for the whole of 2017.
Ronald Timmiss, originally from the UK but living in Mullingar since 2010, told the Sunday Independent that he has been waiting six years on HSE waiting lists for a cataract operation, having been referred to two Dublin hospitals and then to Sligo in 2017 in an effort to get him treated faster.
With still no date for an operation and deteriorating eyesight, last month he travelled to a private hospital in Wales just five days after first contacting a private company (MSC Eurocare) to make the arrangements.
He said he is delighted with the results of the operation - and while he doesn't currently need the cataracts in his other eye removed, he will use the directive if he needs to.
The National Association of GPs (NAGP) encourages its members to refer patients waiting a long time for care to use the directive.
Waterford GP Dr Tadhg O'Carroll said that six of his patients have been referred under this scheme in the last six months, two to the UK and four to Northern Ireland. "All were treated promptly and happy with the outcome. If all other Irish GPs refer at same rate, then over 30,000 will avail of this scheme in a year," he said.
Many TDs are also advising their constituents contacting them about long waiting lists to seek treatment in private hospitals in Northern Ireland under the directive.
The HSE said it has published extensive information on how to use the directive on its website.
"Patients should ask any questions they have directly to the HSE's national contact point, as from time to time we very unfortunately come across patients who have been given incorrect or inaccurate information by third-party providers or healthcare providers abroad. We want to ensure access for patients but we also want to ensure the patient will be eligible for reimbursement," said a HSE spokesperson.
A new dedicated cataract theatre is due to open in Nenagh during the summer, with a new modular one also planned for Waterford, which should reduce waiting times in these areas, which have the longest cataract lists, according to HSE clinical lead for ophthalmology Professor William Power.
Minister for Health Simon Harris last month published a new action plan to reduce the number of patients waiting for hospital procedures. Under the plan, the number of patients waiting longer than nine months will fall by 10,000 and the NTPF will offer treatment to all patients waiting more than nine months in a number of high-volume specialities.
However, the Private Hospitals Association (PHA) has called on Mr Harris to change HSE policy and allow any patient seeking approval for treatment abroad to be first offered treatment here instead within the Irish private hospital system.
"There is irony in the fact that the only place a 13-fold increase in elective treatments has occurred over a two-year period is under the cross-border directive," a spokesperson for the PHA told the Sunday Independent.
"It is deeply unfair to ask patients to walk past an available hospital bed and instead to force them onto a plane and off to a foreign hospital in order to gain treatment.
"Our network of 19 available private hospitals dotted throughout this country can immediately provide all the medical specialities listed in this treatment abroad data.
"It is perverse that the HSE is spending increasing amounts of money under this directive when, bizarrely, the only private hospitals in Europe where patients are not entitled to be treated are those in Ireland," said the spokesperson.
They also pointed out that there is a clinical risk for patients going abroad for treatment, particularly if there are complications or a need for readmission.
For now though, it seems the directive is a good option for those in desperate need of an operation, and facing unacceptably long waits.