Patients on waiting long lists for urgent medical treatment are entitled to be fully reimbursed for the cost of getting care abroad, according to a court ruling issued today.
The decision is pro-patient in that it establishes that the relevant test is whether the patient's clinician believes that a waiting time for surgery is undueLabour Party health spokeswoman Liz McManus
The European Court of Justice (ECJ) found that Briton Yvonne Watts (74), who had been placed on a waiting list for hip replacement surgery, should have been fully reimbursed for obtaining the procedure in France at her own expense.
The preliminary ruling said that where a member state's health service offered the procedure for free, it must provide the treatment in good time or pay for it to be obtained elsewhere in the EU.
It said the determining factor in whether the patient was entitled to paid treatment abroad was based on medical need, rather than the paying body's waiting list targets.
The ruling said: "The competent institution is required to establish that [the waiting] time does not exceed the period which is acceptable on the basis of an objective medical assessment of the clinical needs of the person concerned."
The court also found that costs linked to travelling abroad for the treatment should also be paid, and crucially, that the money should be paid even if the treatment is obtained without the authority of the relevant health body.
The court found that EU law "does not preclude reimbursement of the cost of hospital treatment to be provided in another Member State from being made subject to the grant of prior authorisation".
Ireland has an estimated 30,000 patients on waiting lists for necessary treatment, and some of these are sent abroad under the National Treatment Purchase Fund.
Some have been waiting several years for treatment in the fields of ear, nose and throat; orthopaedics, gynaecology and urology.
The Labour Party's health spokeswoman Liz McManus said the ruling would have implications for Ireland.
"The decision is pro-patient in that it establishes that the relevant test is whether the patient's clinician believes that a waiting time for surgery is undue," Ms McManus said.
She noted however, that the patient was required to pay up front to avail of the EU ruling and expressed concern that people may borrow to fund treatment abroad.
Mrs Watts had severe arthritis of the hips and was in constant pain with restricted mobility. She was initially put on a one-year waiting list and applied to have paid-for treatment abroad in accordance with British legislation.
However the Bedford NHS Trust refused her application, saying it could provide the treatment in accordance to its responsibility to meet waiting list targets.
Mrs Watts then visited a consultant in France who advised she get the treatment urgently, but the trust put her on a three to four month waiting list, in accordance to the advice of her local consultant.
Mrs Watts decided she could not wait, and a month later she was operated on in France at a cost of £3,900. She appealed for reimbursement to the High Court of England and Wales but lost.
But the ECJ today upheld her claim for reimbursement in a preliminary ruling.