Dáil Éireann - Volume 542 - 18 October, 2001

Written Answers. - European Health Services.

148. Mr. Creed asked the Minister for Health and Children the import of the recent European Union ruling regarding entitlement of citizens of the European Union to access health services in other member states; and if his Department will be funding access to these services for persons on the waiting list in other European Union countries. [24750/01]

Minister for Health and Children (Mr. Martin): Regulation (EC) 1408/71, as amended by Regulation (EC) 2000/83, is the co-ordinating regulation covering the referral of patients abroad for benefits in kind, including hospital treatment. This regulation requires that patients seeking hospital treatment in an EU member state other than their own, seek prior authorisation from their competent institution – in the ERHA or relevant health board in Ireland's case – prior to receiving this treatment. The most recent European Court of Justice rulings have not changed this position in that they reaffirm the necessity for a person seeking hospital treatment abroad to seek prior authorisation from the ERHA or relevant health board.

I understand that the European Court of Justice has ruled that due to the specific nature of hospital services member states should not be precluded from restricting the free movement of patients for the receipt of health care where such restrictions can be objectively justified. Three [1077] objective criteria set out by the European Court of Justice are: the ‘risk of seriously undermining the financial balance of a social security system'; ‘the objective of maintaining a balanced medical and hospital service open to all'; and ‘the maintenance of treatment capacity or medical competence on national territory'.

Furthermore, the court has ruled that the granting of an authorisation must be subject to the treatment being regarded as ‘normal' in the professional circles concerned and to the person's medical condition requiring that treatment. In that regard, authorisation cannot be refused on the grounds of the treatment not being ‘normal' where it is considered that the treatment is tried and tested by international science. In addition, authorisation can only be refused on the grounds of lack of medical necessity where similar or equally effective treatment can be obtained without undue delay in the person's member state.

The European Court of Justice has ruled that a scheme of prior authorisation must be based ‘on objective, non-discretionary criteria which are known in advance, in such a way as to circumscribe the exercise of the national authorities' discretion, so that it is not used arbitrarily'. The Department issued directions some time ago outlining the objective criteria which health boards must consider prior to referring patients abroad for treatment.

In relation to the public orthodontic services, I have taken a number of steps to improve their delivery. Structural changes are being introduced and include the creation of the grade of specialist in orthodontics, the development of specialist training programmes and the creation of a grade of auxiliary dental worker to work in the orthodontic area.

An additional investment of £5.3 million – 6.729 million – has been approved for orthodontic services this year, of which £3.7 million – 4.698 million – is to fund an initiative on orthodontic waiting lists. Under the initiative, the health boards are recruiting additional staff and engaging the services of private specialist orthodontic practitioners to treat patients.

The impact of this initiative will be carefully monitored to determine what other measures are required to increase the number of patients in treatment.