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Want to avail of the Cross Border Healthcare Directive? Here’s how

30 June 2017, Sunday Business Post.

Give me the gist of this EU directive?

Groundbreaking EU legislation means that you have the right to receive medical treatment in another EU member state (including the North) and skip Irish waiting lists. The HSE must foot your bill.

What does this new legislation cover?

Virtually all elective treatment, bar organ transplants. It includes everything from hip and heart operations to diagnostic scans. It also includes psychiatric and addiction treatment, as well as orthodontic treatment and rehabilitation. It does not cover long-term nursing home care.

I think I may have heard about this before. Is it related to the E111 or the Treatment Abroad Scheme that RTE reporter Tommie Gorman used?

No. It is completely different. The unprecedented patient rights differ from the European Health Insurance Card (formerly called the E111 for someone who falls ill suddenly) or the pre-existing Treatment Abroad Scheme (which is for treatments that are not available in Ireland). The EU Cross Border Directive deals with patients who need planned procedures (called elective procedures) that are provided in Irish hospitals. Think hip replacements, cataract procedures and so on.

How did this even come about?

Your right to travel overseas for care came about as a result of the European Cross-Border HealthcareDirective. It was fully introduced to Ireland in February 2015. The Department of Health fought hard to avoid signing up to this EU directive due to concerns about the pent-up demand and resulting costs, but was forced to do so.

Do I have to be on a waiting list for a certain amount of time?

No. In fact, you don’t even need to be on a waiting list.

According to the Department of Health: “Referral for care under the Cross Border Directive can be made by a GP, a hospital consultant and certain other HSE clinicians.” In other words, you can bypass Irish waiting lists altogether. Your GP can refer you directly overseas.

So if I am on a public hospital waiting list and have no private health insurance, the HSE now has to pay for me in a private hospital of my choosing overseas?

Yes. It is important to be aware that the HSE will only reimburse you up to the amount it would cost in the Irish public health system.

Are you telling me I can travel to a private hospital overseas and have the HSE foot the bill?


It sounds too good to be true?

It may do, but thousands of patients have already done it. The Department of Health and the HSE have publicly confirmed that the legislation is in place.

Does the HSE really have to pay for this?

Yes. You must stump up the initial payment and the HSE then reimburses you. The HSE must pay the cost of that treatment in Ireland or the cost of it abroad, whichever is the lesser. The HSE promises to do that immediately, upon receiving the invoice.

How will I know what operations cost in public hospitals here to make the comparison?

The HSE office established especially for this (contact details below) can help you do that.

But can a private hospital overseas be cheaper than public hospitals in Ireland?

Yes. Our public hospital costs are extremely expensive – amongst the highest in Europe. Plenty of patients have already travelled to private hospitals in the North and Paris – where they were cheaper.

But I might still be out of pocket for a number of weeks?

That is true. However, credit unions are now providing medical loans to enable more people to use the scheme.

What about my travel expenses?

You must pay those costs yourself.

Why has my GP not told me about this?

Awareness among the medical community is lamentably poor, despite efforts by the HSE unit in charge. Many doctors simply have not taken the time to investigate this option for their patients.

Am I entitled to follow-up care such as physiotherapy at home afterwards?

Absolutely. The HSE has confirmed this in writing.

How do I know where to go overseas, or in the North?

That is up to you. The Department of Health said: “It will be a matter for the patient and his/her referring doctor to identify the clinician abroad and satisfy him/herself in relation to the qualifications, quality and safety of the services being availed of in the other jurisdiction.”

Do I need prior authorisation from the HSE before travelling?

The HSE has set up a National Contact Point Office to administer and oversee implementation of this directive. Prior authorisation is not necessarily needed, but it is required for in-patient treatment (overnight) and more complex care. It is recommended that you discuss your planned treatment with the National Contact Point Office before committing to anything.

How can I find out more?

The HSE’s National Contact Point, Cross-Border Healthcare Directive Department, is based in Kilkenny (Tel: 056 778 4546; Email: Further information is available at the directive website,