Sharp Drop in Cross-Border Healthcare Inquiries Raises Access Concerns
The number of Irish patients seeking information about accessing healthcare in other EU member states under the Cross-Border Healthcare Directive has fallen by 80 per cent over the past three years, according to figures obtained from the HSE's National Contact Point for Cross-Border Healthcare. The dramatic decline has raised concerns among patient advocates and healthcare experts about awareness of the scheme and the barriers that may be preventing patients from using it.
The Cross-Border Healthcare Directive, which came into force in Ireland in 2014, allows patients to access healthcare in other EU countries and claim reimbursement from the HSE for the cost of treatment, up to the amount that the same treatment would cost in Ireland. The directive was intended to give patients greater choice and to reduce waiting times by allowing them to seek treatment abroad when they face long waits at home.
The Scale of the Decline
At its peak in 2021 and 2022, the HSE's National Contact Point was receiving several thousand inquiries per year from patients interested in using the directive. The latest figures show that this has fallen to fewer than 600 inquiries in the past 12 months — a decline of more than 80 per cent. The number of patients actually travelling abroad for treatment under the directive has fallen by a similar proportion.
The decline is particularly striking given that waiting times for many treatments in Ireland remain very long. The number of patients waiting more than a year for outpatient appointments or inpatient treatment runs to hundreds of thousands, and the directive was specifically designed to provide an alternative for patients in this situation.
Possible Explanations
Healthcare experts have offered a number of possible explanations for the decline. One factor may be the increasing complexity of the reimbursement process, which requires patients to navigate a bureaucratic system that many find confusing and time-consuming. The HSE has been criticised for making the process unnecessarily difficult, with some patients reporting that they were unable to get clear information about what treatments were covered and how much they would be reimbursed.
The cost of travelling abroad for treatment is also a significant barrier for many patients, particularly those from lower-income backgrounds. While the directive covers the cost of the treatment itself, patients must meet the upfront costs of travel and accommodation, which can be substantial, particularly for treatments that require multiple visits.
Language barriers may also play a role, with some patients deterred by the prospect of receiving treatment in a country where they do not speak the language. While many European healthcare providers offer services in English, this is not universal, and the prospect of navigating a foreign healthcare system can be daunting.
Calls for Reform
Patient advocacy groups have called on the HSE to take steps to improve awareness of the directive and to simplify the reimbursement process. The Irish Patients Association has argued that the directive represents a valuable resource for patients who are facing long waits for treatment, and that the current low level of usage represents a missed opportunity.
The organisation has called for a dedicated information campaign to raise awareness of the directive, as well as changes to the reimbursement process to make it more accessible and user-friendly. It has also called for the HSE to publish more detailed data on the use of the directive, including information on which treatments are most commonly sought abroad and which countries Irish patients are travelling to.
Government Response
The Department of Health has acknowledged the decline in the use of the directive and has indicated that it is reviewing the information and support available to patients who wish to use it. However, critics argue that a more fundamental review of the directive's implementation in Ireland is needed if it is to fulfil its potential as a tool for reducing waiting times and improving patient choice.
