2026-07-09

96. Deputy Shane Moynihan asked the Minister for Health the steps her Department is taking to address delays in processing reimbursement applications submitted under the cross-border directive; and if she will make a statement on the matter. [52045/26]

98. Deputy Shane Moynihan asked the Minister for Health whether reimbursement under the Cross-Border Directive will include interest costs incurred on bank loans or credit facilities used by patients to fund upfront medical treatment abroad, particularly in circumstances where reimbursement delays significantly exceed indicative processing timelines; and if she will make a statement on the matter. [52044/26]

These questions are to ask the Minister for Health what steps her Department is taking to address the delays in processing reimbursement applications submitted under the cross-border directive. Will reimbursement under the cross-border directive include interest costs incurred on bank loans or credit facilities used by patients to fund upfront medical treatment abroad, particularly in those circumstances where the reimbursement delays significantly exceed indicative processing timelines?

I propose to take Questions Nos. 96 and 98 together. The cross-border directive allows public patients to access healthcare, which they would have been entitled to access in the public healthcare service in Ireland, in another EU or EEA country. As the Deputy is aware, patients pay upfront for the treatment and are reimbursed upon their return to Ireland. We want to support patients in this way and I do not want them to have additional administrative or any form of burden because of the operation of this scheme. The HSE is responsible for the operation of the cross-border directive and has a dedicated office for that purpose. There has been continued growth in use of the scheme. The HSE tells me that this has placed additional demands on the HSE cross-border directive, CBD, office and given rise to a build-up of applications. The increased activity is evidenced by the number of treatments reimbursed increasing by approximately 75% between 2020 and 2024. Nevertheless, it is important this service operates in a responsive way and that reimbursement applications are processed within a reasonable timeframe. The HSE advises that it usually aims to repay patients within 30 days of receipt of all completed documents. However, the HSE also advises that it is currently processing applications received in mid-January 2026. A six-month delay for reimbursement is absolutely unacceptable. It is not fair to patients to have an additional financial burden placed on them that is occasioned simply because of administrative delay, notwithstanding the increase in applications. Accordingly, the HSE has advised my Department that additional resources are being assigned to manage this increase in demand with the aim of restoring processing times back to expected and more acceptable levels. I have, however, set the HSE a very specific target of getting back to the 30-day target by the end of 2026. It will need to sort this issue out between now and then and get back to that 30-day target. It is not reasonable to put administrative stress, financial stress or other burdens on people in addition to their healthcare issues. As the Deputy knows, the reimbursement amount is the cost of the treatment in Ireland or the cost of it abroad, whichever is the lesser. Reimbursement is confined to the costs of the care itself and does not include any additional costs incurred by the patient. This is not the Deputy's question, however. His question is about the timeline, and I hope I have given him some confidence that this will be changed by the HSE.

I thank the Minister for that very comprehensive answer. I welcome her support and proactiveness in getting the HSE to commit to that timeline. I have a few follow-up questions. This is around confidence-building. It is a very useful directive and gives us additional capacity in getting people the treatment they need. From my understanding of how the scheme operates, it centres on a small number of providers and hospitals because of the specific procedures that are there. As the Minister said, waiting six months for reimbursement is onerous, especially if it is an older relative or someone who has been waiting for a long time. Could the Minister say a bit more about whether any consideration can be given to a situation where a family, not of substantial means, has had to take a loan to pay for the overall cost of the treatment and because they have not been able to repay that loan, or because the reimbursement has been delayed, this has led to interest being accrued on the credit facility they took? Is the HSE considering providing alleviation for families who find themselves in those circumstances through, as the Minister said, no fault of their own? It is unacceptable they should have to wait that duration of time to receive the reimbursement due to them and they then have to pay an additional interest or credit charge on top of that. There is a question of fairness. I fully appreciate and am grateful to the Minister for driving the HSE to get back to a 30-day target by the end of 2026. How confident is the Minister that it will do that? Is it allocating additional staff? What exactly does additional resource look like? Will the HSE report to the Minister with an interim progress report before the end of the year to see how this is tracking? Has the HSE made any substantial progress in addressing that target in the meantime? It is a good directive and scheme. From a political point of view, we are very supportive of this but it is also about making sure patients relying on it get the reimbursement they are due. As I am sure the Minister will agree, we do not want to cause more hardship to or place onerous pressure on people who may have been through a procedure or have had a loved one go through a procedure. Will the Minister share her thoughts on the staffing, her confidence that the HSE will reach the target and the refund of interest on credit facilities?

I cannot speak to the specific staff numbers. I generally find it is about process change as much as staff increases, so I think it is a measure of both. I will look for an interim report, probably in October, as to how the work is going. I made the point that it is possible to change processes. For example, this time last year, I gave the Medical Council a significant challenge to sort out its backlog of people applying to be doctors in this country. It was a patient safety issue not to have had them. By September, it had that done. These things can be done with a measure of focus, and I expect it to be done in this case. In relation to the specific question about interest and bank loans, there is a difficulty with this. The reimbursement is limited to the eligible healthcare costs that would have been met by the public health service. There is no provision for the reimbursement of interest charges, borrowing costs or other consequential financial costs. Reimbursement under the cross-border directive is governed by European and national legislation. Reimbursement of additional costs is not envisaged by the directive because it was never expected people would be waiting in that period. I appreciate the unfairness point the Deputy made. That is why I am saying these delays are absolutely unacceptable and we need to get back but there is not provision in that scheme. We have no flexibility to change a European scheme of that kind in relation to additional costs beyond the healthcare costs.

I thank the Minister for her response, in particular on the process change. If possible, will the Minister tell us if there are particular processes the HSE has identified which it thinks could be changed to speed this up? I am always reluctant to say we need to throw more staff at a problem, especially when it is administrative, because, as the Minister said, more often than not a system change is needed or there are unnecessary barriers in processing which cause delays. I fully accept the Minister's point that the directive is European legislation but the European legislation did not envisage it would take six months to reimburse an application. In that vein, is there any consideration that can be given internally for the HSE to look at what it might to do remediate and compensate the people who, through no fault of their own, are left to pay large amounts of interest they did not envisage when they took out the loans? That was not an expectation of the scheme when it was set up. It certainly was not the expectation of the patients when they applied for the scheme but, with all due respect to all involved, the HSE is the one at fault for the delay. There should be some indication or signal from it about how it might compensate or at least take account of the fact that the interest accrued or credit facilities people took have given rise to additional bank charges on the fees. From a human point of view, families who have gone through the stress of having to travel abroad to get a procedure are expecting reimbursement. Six months down the line, they have not been reimbursed and are hit with extra interest or bank charges. This was not envisaged by the European legislation. I fully accept the point on flexibility and the parameters but given that this is a process issue related to the administering of this scheme, will the HSE look at compensating for or taking account of that in the reimbursement process?

I appreciate the point the Deputy is making but I am not going to make any commitments or policy on the floor of the House. I am also operating without information on the specific patients, the duration or the interest costs. I do not have any of that information but if the Deputy wants to speak to me about the matter privately, I will be happy to look at it. However, I will not make promises I cannot deliver as it would not be right for me to do so. I appreciate the Deputy's point and his reasoning.