Can I access planned medical treatment in another State?

Citizens may make an application to their local Health Authority for authorisation to travel to another Member State of the European Union to receive medical treatment there.  For example, it is possible for a citizen resident in Ireland to obtain authorisation to receive medical treatment in Germany or Austria or any other Member State of the European Union.  Authorisation is generally required from the Health Authority in the home State where the treatment is not available in the home Member State or where the treatment cannot be provided in the home State without undue delay.

If the authorisation to obtain treatment in a hospital or institution in another Member State is granted, the cost of the treatment will be paid for by the Health Authority in the citizen’s home State. This means that where a citizen who is resident in Ireland obtains authorisation to receive medical treatment in Germany, the cost of the treatment will be paid by the Irish Health Services Executive.

Example

Bridget requires a hip replacement.  She has been seen by a consultant who has advised that the waiting list is now eleven months.  She has been advised that she can obtain a hip replacement within four weeks in France at a cost of approximately 5,000 euros for the operation.  She can apply to her local Health Services Executive office for authorization to travel to France for the operation.  If this is granted, the cost of the operation will be paid by the Health Services Executive in Ireland.  Bridget may also be able to claim travel and accommodation costs from the Health Services Executive.

What factors will the Health Authority take into account when considering granting authorisation?

Where the treatment is not available in the home Member State, the Health Authority may consider the following:

• whether there is urgent medical necessity for the treatment;

• whether there is a reasonable prognosis;

• whether the treatment is regarded as a proven form of medical treatment;

• whether the treatment is to take place in a recognised hospital or other institution and is under the control of a registered practitioner.

Based on the recent Watts case (C-372/04), where the treatment is available in the home State but the treatment cannot be provided without undue delay, the Health Authority should also consider whether the waiting time for the treatment in the home State exceeds the period which is acceptable in the light of a medical assessment of the following:

• the clinical needs of the citizen in the light of his/her medical condition;

• the history and probable cause of illness;

• the degree of pain;

• the nature of the disability at the time when the authorisation is sought.

Under what circumstances is the Health Authority entitled to refuse to grant authorisation?

The Health Authority is entitled to refuse to grant authorisation to a citizen to receive healthcare in another Member State if any of the above conditions are not met and, in addition, where the refusal ofauthorisation can be justified in the light of overriding reasons.  For example, where the Health Authority wishes to ensure:

• that there is sufficient and permanent access to high quality hospital treatment; and

• that costs are controlled; and

• wastage of financial, technical and human resources is prevented.

These reasons must satisfy the requirement of proportionality.

How can I apply for healthcare in another Member State from Ireland?

In Ireland, there are a number of steps to be completed by a citizen seeking to obtain medical treatment in another Member State:

1. The citizen is advised by his/her consultant that certain medical treatment is necessary.  If the treatment is not available in Ireland or the treatment cannot be provided without undue delay, the citizen may opt to apply to his/her area Health Services Executive office to obtain authorisation to obtain the treatment in another Member State of the European Union in an institution identified by the citizen.

2. The citizen obtains a Form S2 (previously, the E112 application form)  from his/her area Health Services Executive office.  The S2 Form allows you to prove your entitlement to planned health treatment in another Member State or in Iceland, Liechtenstein, Norway or Switzerland.  It acts as authorization from the HSE that you can obtain the planned treatment in another Member State.  You must obtain it from your health insurance institution before leaving and then submit it to the health insurance institution in the country where you go to receive the treatment. Treatment will be provided to you under the same conditions of care and payment as to nationals of the country where you receive the treatment.  This could mean that you have to pay some of the costs up front.

3. Where authorisation is granted by the Health Services Executive office to the citizen to obtain the treatment in the specified institution, the Health Services Executive will agree to pay the costs of the treatment in addition to certain travel and subsistence costs.

Where can I find out more about making an application for planned medical treatment in another Member State?

Further information on making an application for medical treatment in another Member State is available from your area Health Services Executive office. Click here for contact details of the Health Services Executive offices in your area.  

Further information on planned medical treatment in another Member State is available on the following website:  http://ec.europa.eu/social/main.jsp?catId=569&langId=en