Europe and Brexit

Limited cross-border health scheme installed

A healthcare scheme which enabled Northern Ireland patients to be reimbursed for some treatments in other EU members states has been partially reinstated to allow for cross-border healthcare in the Republic of Ireland, but only for one year.

Health Minister Robin Swann MLA announced in June that he was to reinstate a limited version of the Cross-Border Healthcare Directive (CBHD) as a temporary measure to help ease some of the burden on Northern Ireland’s waiting lists.

The scheme, which has been responsible for over 3,000 patients from Northern Ireland being reimbursed for an estimated £14 million worth of cross-border treatments between April 2016 and 31 December 2020, was a casualty of Brexit, closing for UK patients and also meaning EU patients could no longer use the CBHD scheme to access health in the UK.
The scheme was popular because it enabled reimbursement for both private and state-funded treatments, with figures for the five years before the end of the Brexit transition on 31 December 2020 showing over £50 million reimbursed in Northern Ireland and the Republic of Ireland.
The Irish Government proactively set up a temporary scheme (12-month) for Irish residents seeking treatment in Northern Ireland. However, the Northern Ireland Planned Healthcare Scheme, introduced on 1 January 2021, was unilateral and it was not until June 2021 when Northern Ireland’s Department of Health announced a similar scheme.

Figures gathered by the BBC show that Ireland’s health service reimbursed 16,500 applications through CBHD in the past five years, at a cost of around £40 million. Of these, over 95 per cent were requested for treatment in Northern Ireland.
For the same time period, Northern Ireland’s Health and Social Care Board spent £14 million reimbursing Northern Ireland patients for treatment in the EU, including in the Republic of Ireland.
Announcing the Republic of Ireland Reimbursement Scheme, Health Minister Robin Swann said that the framework, based on the Cross-Border Healthcare Directive, will allow patients to seek and pay for treatment in the private sector in Ireland and have the costs, up to the cost of the treatment in health and social care in Northern Ireland, reimbursed by the Health and Social Care Board.

Patients may seek and pay for “routinely commissioned treatment” in the private sector in the Republic.

All treatments need to be pre-authorised before a patient can go into the Republic to have their treatment carried out and travel and accommodation costs cannot be reimbursed, while long-term care is not paid for by the scheme. Similarily, organ transplants and public vaccination are excluded from the scheme.
However, the Minister admitted that the scheme will not have a dramatic impact on waiting lists in the Northern Ireland.
“A key principle of our health service is that access to services is based on clinical need, not on an individual’s ability to pay. However, we are in exceptional times, and we must look at every option to tackle the waiting lists in Northern Ireland,” he explained.
“Reinstating a limited version of the Cross-Border Healthcare Directive to Ireland will not have a dramatic impact on the overall waiting lists, but it will provide an opportunity for some to have their treatment much earlier.”
It remains to be seen whether a long-term solution will be agreed across both jurisdictions in Ireland beyond the end of the temporary schemes in place in both jurisdictions.

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