Senior HSE managers have expressed alarm that an EU healthcare directive - which allows patients to obtain care abroad and recoup the costs from the State - could have major cost implications.
Under the Cross Border Directive, introduced on June 1st last year, any public patient with a referral letter from their GP or consultant may obtain treatment in another member state and claim reimbursement from the HSE.
It is separate to the "travel abroad scheme", which is limited to patients whose treatment is either not available in Ireland or where there are delays accessing care in Ireland.
The cross-border scheme, however, is not limited to patients on waiting lists and covers most areas of healthcare, including acute hospital procedures, dental care, speech and language therapy, as well as physiotherapy, disability and mental health services.
Long-stay care, such as nursing home care, is exempt, as are organ transplants.
‘High level risk’
Internal records released to The Irish Times describe the cross-border directive as a “high level risk” for the HSE, with significant implications for the health budget.
“There are implications for the health services who have committed to a level of activity in their service plan and who may be required to pay for out-of-State provision from their budgets,” states one internal HSE document prepared for the 2015 estimates.
While the scheme has the potential to provide timely treatment for tens of thousands of patients, awareness of it remains limited.
The European Commission was forced to send a formal request to the State last year to implement the healthcare directive after it failed to meet a deadline for October 25th, 2013.
The directive eventually came into effect in June last year.
Latest figures show waiting lists are at a record high, with almost 415,000 people waiting for outpatient appointments and a further 67,000 for inpatient or day care treatment last month.
Declan Doyle, a citizen who has been campaigning to spread awareness of the directive, has called on authorities to ensure all patients are made aware of their rights.
“Many thousands of Irish citizens, adults and children, must suffer in pain while waiting for hip and knee replacements, in the case of many adults, and for orthodontic treatment, in the case of children,” he said.
"The HSE and Department of Health should urgently notify anyone on a waiting list or who is unable to get an appointment to see a specialist of their right to travel on the basis of a GP referral only," he said.
Under the scheme, applications whose treatment requires an overnight stay are required to secure prior authorisation from the HSE before travelling abroad.
These applications are typically processed within 15 to 20 working days, according to the HSE.
The healthcare directive does not cover travel costs, and individuals seeking treatment outside the State will require up-front funding for any treatment.
Mr Doyle said that credit unions could develop a health bridging loan product to allow citizens to pay for their treatment.
The directive ensures that states must reimburse the patient promptly after their return home.