There was a time most of us would baulk at the idea of going abroad for an operation but times, travel and lengthy public patient waiting lists are making the option more attractive now.

Also, while the HSE provided information to help users of the scheme since it began in 2014, agencies or facilitating companies have now sprung up to help people through the process.

These companies get an administration fee from the hospitals they send patients to, rather than from the patient.

HSE figures show that interest in the scheme is strong. While only 30 people travelled abroad for their operations in 2014, that figure rose to 3,508 in 2018. In total, the HSE paid out €11.1m, in reimbursements last year.

That’s an average of €3,164 per patient.

How exactly does it work?

  • The Cross Border Directive gives Irish patients the choice of receiving healthcare in another EU or European Economic Area (EEA) country.
  • Under the scheme, anyone living in Ireland for at least one year can apply to access healthcare in another EU/EEA country as long as they are a public patient on a public health waiting list. You don’t have to be on the list long but you will need a GP referral letter.
  • Last year the most popular choices were the UK and Poland.
  • Reimbursement is straightforward and is supposed to take 20 working days but the response time is now 50 working days due to the scheme’s popularity and staff resource issues, Irish Country Living has learned.
  • Your GP can refer you as a public patient to a hospital in EU or EEA countries where you can be treated in either a public or private facility.
  • The healthcare you get must be what is available and funded in the Irish public healthcare system. However, you will need prior approval for some treatments.
  • When you come home, you complete the HSE CBD pro forma invoice and submit it to the HSE with your invoice and receipt from the hospital abroad.
  • Most procedures are covered as long as they are covered by the Irish health service. Organ transplant is an exception.

    • Operations in the UK

    Cataract operation in the UK

    Bob Bennett (71) is a retired dairy farmer from Glanmire, Co Cork. He had two cataract operations in the Oakland hospital in Manchester this year.

    “The cataracts meant it was like trying to look through a dirty windscreen,” Bob says. “The glare of the sun or lights would dazzle you too.”

    Bob was told that, as a public patient, he’d have to wait two-and-a-half years for an operation.

    “I couldn’t wait that long and when we read about the Cross Border scheme last winter we decided to go for it. I am the kind of person where if there is something wrong I get it fixed.

    "The CB is a great scheme where you don’t have to wait if you don’t want to.”

    Each cataract operation cost him €1,548 and he is currently awaiting reimbursement for both operations from the HSE.

    Bob chose to contact Charter Medical, one of the companies acting as CBD facilitators.

    Just as several other companies do, they talk you through the process, provide a list of accredited hospitals and organise the journey there and back.

    Bob Bennett speaks highly of their help.

    “They were with us every step of the way. Everything was organised from home to back home again.”

    Hip operation in the UK

    Retail manager Daniel Lehane from Drogheda was on a waiting list for a hip replacement operation for 18 months when a colleague told him about the CBD scheme.

    He then organised to have the operation in the UK following serious pain.

    “I wouldn’t wish it on my worst enemy,” he says.

    Daniel, like Bob Bennett, chose to book the operation with Charter Medical’s help.

    “The cost was €11,060.16 but they pointed me in the direction of a credit union and I got a bridging loan two weeks later. I had the operation a couple of weeks after that.”

    Costs included paying a (refundable) deposit of €200.

    “The only expense I had to cover was one night in the hotel,” he says.

    Daniel is awaiting reimbursement while also paying €50 a week to the Credit Union, but he will get that back, he says.

    Knee replacement in the UK

    PJ McMackin (46) from New Ross, Co Wexford, works in the meat industry and he travelled to the Royal Orthopaedic Hospital in London for a full knee replacement operation in February 2019.

    He had paid €4,000 last summer for a cartilage procedure but this didn’t work so he went on a public waiting list for a knee replacement.

    “The thought of waiting 30 months was terrible but with the operation costing €14,500 here I knew I couldn’t manage it.”

    PJ was glad when a cousin’s internet search led to him choosing the CBD option. He accessed it with the help of borrowed money and Trasna.com in Waterford.

    “I can’t sing their praises enough,” he says. “I rang on the 10 January and I had the operation on 28 February.”

    “Everything went smoothly,” he says, “and I went to my sister’s in the UK for a week’s convalescence after. Three months later I’m back in work on light duties.”

    He is waiting for reimbursement now.

    PJ says that having to pay for one’s physio sessions afterwards is a drawback, however.

    “€50 a week for physio after the operation can be a lot when you’re not working, but there’s a waiting list and you can’t wait.”

    How facilitation companies work

    While you can make arrangements yourself in order to avail of this scheme, some people choose to use the services of a facilitation company. Here are details of the two mentioned:

    Charter Medical

    Charter Medical partnered with Ramsay Healthcare, the fourth biggest hospital operator in the world, to get access to its 235 hospitals, including 34 in the UK.

    They arrange a fitness to travel medical review for the patient at their clinic in Smithfield Dublin, as well as patient travel and accommodation.

    These are all free to the patient, they say.

    “We have found that patients are particularly interested in having their surgery done in UK hospitals because there is no language barrier and it is a short trip from Ireland,” says Dr Richard Aboud, clinical director of the programme.

    “We also needed to ensure that the patients do not incur any charges that are not reimbursed by the HSE. The majority of our referrals have come from GPs.

    "The patient’s GP is also kept informed of the patient’s surgery and outcomes to ensure seamless care between the patient’s own doctor and the surgeons at Ramsay Healthcare.”

    www.chartermedical.ie

    trasna.com

    Trasna Healthcare was set up by ex-BUPA MD, Martin O’Rourke, last October and also assists CBD applicants who want help with the practical details.

    “We have over 34 partners in our network of hospitals, covering the UK, Spain and France, so there is a selection to choose from,” Bronagh Twomey of Trasna says.

    “We consider ourselves navigators. The patient contacts us, we present them with options – prices in different hospitals, for example, and what the HSE pays for that operation – then we assist them the whole way through. The UK is definitely the most popular choice,” she says, “but often people choose to go where they have family.”

    www.trasna.com

    Credit Union help

    Facilitating companies can provide a detailed letter of the patient’s travel and treatment plans for their Credit Union.

    “We have found credit unions more than accommodating and it fits in with their philosophy as well,” spokespeople say. “If the person’s credit situation is good things can move along very quickly.”