When we are sick the vast majority of us would prefer to be treated at home in a familiar environment surrounded by family and friends.
However, for some that is not possible, and every year hundreds of Irish people, either by choice or necessity, make the decision to travel abroad for medical treatment.
The options available to people who travel abroad for treatment are varied.
Some private health insurance companies cover the costs of people who wish to access treatment abroad subject to terms and conditions of their cover and pre-approval by the company.
To date the only option available to Irish patients without private health insurance, however, has been the HSE’s treatment abroad scheme (TAS) but this is due to change shortly following recent changes to EU law.
Under TAS, patients can apply to receive treatment in another EU country but it must be proven that the treatment is not available in Ireland.
In order to access the scheme, the treatment must be approved by the referring consultant in Ireland.
The treatment cannot be an unproven therapy, for example, part of a clinical trial, and it must be carried out in a public hospital within the EU.
Travel costs
Under the scheme, the HSE covers the cost of medical treatment only and it is not required to cover travel costs.
However, in 2010 the HSE introduced a national travel policy which covers some travel costs for the patient, and in certain circumstances the costs of a travelling companion are also reimbursed.
According to the HSE, “the TAS also allows for patients to be referred abroad for a treatment available in Ireland but which cannot be accessed in a timely manner”.
“To use this criteria, the referring consultant must demonstrate the extent to which the patient’s condition will deteriorate beyond that which can be achieved by a more timely intervention.”
Ann Brehony accessed TAS twice for her son, Rory Barrett, who was born in 2003 without any kidneys. As Rory’s condition is extremely rare, he needed specialist treatment in London in 2009 and 2012, and both treatments were paid for under TAS.
While Brehony stated that TAS was initially difficult to navigate and the process itself extremely challenging at times, once she got approval, the scheme worked well for her and her son.
“It is like everything in the Irish health system, once you get in it is brilliant . . . you just bring a form with you to be stamped and you don’t have to think about a medical bill after that.”
Rory was treated successfully in the UK and, according to Brehony, the team in Great Ormonde Street were full of praise for the care Rory had received in Ireland.
Brehony herself was full of praise for the HSE staff who run the TAS office in Kilkenny, saying they were extremely professional and very helpful.
A total of 868 applications were made to the HSE’s TAS in 2012 and, of these, 791 were approved.
In 2012, the HSE spent a total of €7.4 million on the treatment of Irish patients aboard. However, it is important to note that these figures are subject to change as invoices from other countries are received in arrears.
The more common treatments that Irish patients access abroad include deep brain stimulation (used to treat a number of neurological conditions), heart and paediatric liver transplantation, as well as specific cancer care that is not available in Ireland.
The UK, Sweden, Germany and Belgium are the countries which patients are most frequently referred to.
Private insurance
Patients who do not qualify for TAS and have private health insurance may be able to access treatment abroad depending on their level of cover.
Two of the three main private health insurance companies in Ireland – Laya Healthcare and Aviva – provide cover for members who choose to travel abroad for treatment, while VHI Healthcare may provide cover "in exceptional circumstances".
A VHI Healthcare spokesperson said the company “does not provide cover if the customer travels abroad specifically to get treatment”.
“However, in exceptional circumstances, and subject to prior approval, cover may be provided up to the normal limits that would apply, ie between €65,000 and €100,000 depending on plan cover held. In such cases, the costs are allowed towards medical expenses only.”
According to Laya Healthcare, members have access to medical tourism and treatment outside Ireland within the EU. Any procedures are subject to pre-authorisation by Laya’s medical advisory panel.
In 2012 Laya approved just under 100 requests for overseas treatment, with the top countries being the UK, France and Germany.
According to Aviva Health Insurance, “If the treatment is available in Ireland but the member would prefer to be treated in another country, Aviva Health will pay for the treatment to the same value of getting treated in Ireland.
“If it’s a case that the treatment is not available in Ireland but is available in another country, Aviva will pay the amount of the nearest similar treatment that is available in Ireland. The treatment in question must be medically proven.
“The cover on the majority of plans covers surgical treatment, not travel costs,” Aviva added.
For those patients who do not qualify for TAS and who do not have private health insurance, the options available to date have been limited.
However, on October 25th last the Directive on Patients’ Rights in Cross-border Healthcare came into force throughout the EU. Under the directive, which has yet to be transposed into Irish law, patients will for the first time be able to avail of healthcare in another EU country and seek reimbursement for it.
Unlike TAS which provides only public cover, the new directive will allow patients access care in a private or public facility abroad.
Filling prescriptions abroad
In another first for cross-border healthcare, the new legislation will also allow Irish patients to get their prescriptions filled in any EU country.
In a statement the Department of Health said it was continuing to work on the necessary statutory provisions to fully implement the directive which it hoped to do "as soon as possible".
Further information on Ireland's implementation of the directive is available on the HSE's cross-border healthcare web page: iti.ms/KZO7Xl
Reinhard Schäler: Travelling from Ireland to Germany with Pádraig
“I thought it was maybe a bad dream and you wake up in the morning and think maybe I have imagined all of this. But then you realise that it is for real and it is also something that is not going to go away any time soon.”
This is how Reinhard Schäler describes the experience of living with the horrific aftermath of his son Pádraig's accident which almost claimed the 23-year-old's life.
Road accident
Last summer after completing a degree in history and Irish in Trinity College Dublin, Pádraig Schäler went to work in the US where tragically he was involved in a serious road accident which left him with a catastrophic brain injury.
After spending a number of weeks in intensive care in a US hospital, Pádraig was flown home to Ireland, where he remained for a number of months in a high- dependency unit in an acute hospital.
In November last year the family transferred Pádraig to a specialist rehabilitation centre in Germany as they were told that it could take up to nine months before a bed would be available at the National Rehabilitation Hospital (NRH) in Dublin.
The family believed they could not wait that long. They also felt that an acute hospital setting was not an appropriate place for their son and he would be best cared for in a specialist rehabilitation centre.
However, there are just three beds in the NRH for patients like Pádraig who are minimally conscious and have specialised clinical needs.
Schäler believes it is “outrageous” that there are just three public beds available in Ireland for patients like his son.
He also feels it is inadequate to have patients waiting in an acute hospital for months before they can access specialist care.
Luckily, as Pádraig has dual Irish and German citizenship, the family was able to get insurance cover for his treatment in Germany.
Reinhard and his wife both work in Ireland, and have other children to care for. However, their devotion to Pádraig means that they spend their time travelling between Germany and Ireland.
Pádraig remains on a respirator and in a coma in the German facility and the prognosis is difficult . However, despite Pádraig remaining minimally conscious, his father says over the past few weeks his son is beginning to react to his surroundings.
Little choice
The decision to move Pádraig to Germany has been a difficult one for the Schäler family but one in which they believed they had little choice.
“I felt very much let down,” Schäler says. “I have lived more than half of my life in Ireland . . . I have worked there almost all of my adult life. I have paid my taxes . . . my social insurance and I thought that if anything goes wrong there is a health service there that looks after me and my family.
“And well, what I found out was that was not the case.”
In a statement the NRH said: “Patients with disorders of consciousness or minimally conscious conditions require high staffing levels based on the patients’ specialised clinical needs – the capacity of the NRH to admit patients within this patient population is currently limited to three beds due to staffing resources and number of beds funded.” It pointed out that average length of stay for these patients is three months, so it has the capacity to treat 12 such patients every year.
