Ombudsman finds HSE did not reimburse legitimate claims for treatment abroad

A report entitled In Sickness and in Debt, published today, makes 21 recommendations for better management of three schemes. The recommendations have been accepted by the HSE. 

The HSE has been refusing to reimburse often elderly and vulnerable patients’ legitimate costs for going abroad to seek treatment because they couldn't get the operations here, the Ombudsman has found.

The delays in reimbursing patients or withholding of the funds due to them under EU health schemes drove patients into debt, said Ombudsman Ger Deering.

In one case the HSE tried to take back a payment of €11,500 from an elderly woman, to her “great distress”, because she receives a UK pension. The Ombudsman found the initial forms she filled in contained no pension questions.

“Many of the complaints we received were from patients who needed access to common treatments such as hip replacements or cataracts,” said Mr Deering. 

“These were treatments that if received in a timely manner would have a life-changing impact on their day-to-day living.” 

Often they were elderly and their everyday quality of life was severely impacted by their condition.

The schemes tend to be used by people who have waited years on hospital waiting lists and are referred abroad by GPs with the understanding this cost will be paid back. 

Mr Deering said: "People had borrowed significant amounts of money from family, friends, or financial institutions to pay for their treatment with the expectation that they would be able to pay them back when reimbursed by the State." 

In Sickness and in Debt

A report entitled In Sickness and in Debt, published today, makes 21 recommendations for better management of three schemes. The recommendations have been accepted by the HSE. 

“The HSE is committed to making the required changes in the delivery of these schemes as outlined in the report and to provide ongoing assurance that the changes are being implemented,” said a spokeswoman.

She defended the scheme, saying last year, for example, €30.9m was approved for 4,809 applications.

While Mr Deering accepted “in the main” the schemes work well, he said this report “identifies when the schemes do not work well”.

“Ultimately, these patients replaced their fight to get treatment with a fight to be reimbursed by the HSE,” he said.

“Those that had borrowed money for their treatment also faced a fight against falling into debt. Unfortunately, many of the complaints that I received as Ombudsman were from patients that now face such debt.” 

The report shares patient's waiting list challenges, including one person who was told of a four-year wait for an appointment in Ireland.