Dáil Éireann Debate, Tuesday - 4 July 2006
201 Mr. Lowry asked the Tánaiste and Minister for Health and Children the measures which will be implemented by the Health Service Executive as a result of the EU decision on allowing EU citizens the right to travel outside of this State for medical surgery at the expense of the State; if she has an indication of the costs involved in this measure; and if she will make a statement on the matter. [25827/06]
View answerRegulation 1408/71 is the co-ordinating regulation covering the referral of patients to another EU/EEA member state for healthcare benefits in kind, including hospital care. This regulation requires that patients seeking to travel to another EU/EEA State for the purpose of receiving hospital care must obtain prior authorisation from their competent institution (HSE in Ireland) prior to receiving treatment. In circumstances where a person requires specific treatment that is not available in Ireland, or is not available within the time normally necessary for obtaining treatment in question taking account of the persons current state of health and the probable course of the disease, the HSE may issue the form E112 authorising the provision of treatment in another EU member state, having regard to the established criteria. The issue of the form E112 involves a commitment by the HSE to pay for the cost of the treatment.
The European Court of Justice (ECJ) has ruled, most recently in the Watts case (Ref: C-372/04), that EU member states are not precluded from restricting the free movement of persons for the purposes of receiving healthcare in another EU State, including the requirement to obtain prior authorisation, where such restrictions can be objectively justified. The risk of seriously undermining the financial balance of a social security system, "the objective of maintaining a balanced medical and hospital service open to all" and "the maintenance of treatment capacity or medical competence on national territory" are three such objective criteria set out by the ECJ. However, these rulings also stipulate a number of conditions where prior authorisation may not be refused, including that authorisation may not be refused where there is "undue delay" in providing appropriate treatment in the person's Member State. A scheme of prior authorisation must however be based on "objective non-discretionary criteria which are known in advance, in such a way as to circumscribe the exercise of the national authorities' discretion, so that it is not used arbitrarily".
Referral of patients to non-EU countries and contracting out of cases to other EU member states, primarily the United Kingdom, and the United Sates are outside the terms of Regulations 1408/71 and rulings of the ECJ in this context.
Ireland has and continues to use the relevant provisions of Regulation 1408/71 to refer patients primarily to the UK in circumstances where appropriate treatment is not available in this country. In 2004 the cost of referrals to the UK was in the region of €4.8m, whilst the figure for 2005 was approximately €2.4m. At this time, it is not expected that the ruling of the ECJ in the Watts case will have any significant impact on the level and cost of referrals made under this Regulation.
