HSE approach to overseas treatment ‘inflexible’ and often to blame for patient debt, Ombudsman finds

The Health Service Executive repeatedly refused to reimburse the legitimate expenses of patients who had necessary medical treatments in other countries and this forced many people into debt, a damning report published by the Ombudsman states.

The investigation found that the HSE adopted an “unreasonable and inflexible approach” when it came to administering schemes to fund health treatments abroad that the State system is either unable to provide or unable to provide in a timely manner.

In his report, In Sickness and in Debt, Ombudsman Ger Deering said some patients faced a fight to be reimbursed for the legitimate costs they had incurred for necessary treatment received abroad, with many borrowing money and some falling into debt as a result. In other cases, approval to have treatment abroad was unreasonably refused or delayed.

The HSE refused to reimburse one patient who paid for treatment overseas on the grounds that their GP had not signed a letter of referral he emailed to a hospital in Northern Ireland.

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“This was despite the fact that it was clear that the letter was sent from the GP’s email address, and the GP had assured the HSE in writing that the referral was genuine,” the report says.

Another referral letter from an Irish GP was addressed to the relevant section of a Northern Ireland hospital and not a named individual in that hospital, which prompted the HSE to reject the claim. Its intransigence was further highlighted when it “refused to accept a subsequent amended referral letter from the GP”.

In another instance, a payment was refused because a treatment which had a waiting list of four years in Ireland took place in Belgium, but the initial consultation took place while the Belgian consultant was in Ireland.

In a separate case highlighted in the report, someone who was “in urgent need of treatment for chronic back pain” had their case rejected by the HSE because prior to treatment in Poland, an outpatient consultation with a Polish consultant took place by phone rather than in person.

A number of older patients who sought refunds for treatment were in receipt of UK pensions. Due to the lack of information provided by the HSE, these patients were unaware that the fact they were in receipt of a pension from another EU country would negatively affect their application.

The patients had borrowed significant amounts of money to have the treatment but received no reimbursement.

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In the report, the Ombudsman sets out 21 recommendations to improve the administration of the schemes for the benefit of patients who need these critical treatments. Following discussions between the Ombudsman and HSE chief executive Bernard Gloster, the HSE has agreed to implement all the recommendations.

“I very much welcome the decision of the HSE to implement the recommendations,” Mr Deering said. “Their implementation will have a significant positive impact on the lives of those who need to access treatment abroad, and will help ensure that decisions under the schemes are focused on the patient’s needs.”

The Ombudsman’s investigation included an examination of the EU cross-border directive scheme. Under the scheme, the patient pays for necessary treatment in another EU or EEA country upfront and then applies to the HSE for reimbursement of the cost of the treatment.

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The Ombudsman’s report also contains recommendations in relation to two other schemes – the Treatment Abroad Scheme and the Northern Ireland Planned Healthcare Scheme – a scheme brought in to provide for treatment in Northern Ireland following Brexit. A small number of recommendations are relevant to the Department of Health, which has accepted them.

In a statement, the HSE said it approved almost 5,000 applications for people living in Ireland to avail of healthcare treatment from another EU/EEA country or the UK with a combined cost of €30.9 million for reimbursements.

It said that “in the main these schemes work well” and it was “committed to making the required changes in the delivery of these schemes as outlined in the report”.