a country · IrelandIreland

A country that mostly sends patients out and takes very few in. The driver is the public hospital waiting list, which the National Treatment Purchase Fund publishes every month, and there are three ways off it that involve leaving: the Cross Border Directive scheme to another EU or EEA state, the Northern Ireland Planned Healthcare Scheme to private providers across the land border, and the Treatment Abroad Scheme, which is Ireland's S2 route for care the public system cannot provide in time. All three end in a form. Two of them start with the patient paying the bill.

The queue first, because everything else follows it. At the end of August 2026 the NTPF counted 687,839 people waiting for a first hospital outpatient consultation, 114,921 waiting for an inpatient or day case appointment, and 42,726 waiting for a GI endoscopy, with a further 37,951 suspended and 113,675 on the planned procedure list. Those are counts of people waiting, not waiting times; the NTPF publishes no median, so this record carries none.

The outbound flow is then measured, unusually well, from the money. The European Commission's data for reference year 2024 records Ireland receiving 2,566 requests for reimbursement of care not subject to prior authorisation and granting 2,266 of them, and paying out €11,881,494 — an average of €5,243 per granted request, the second highest in the European Union after Cyprus and nearly four times the EU average of €1,351. Only five countries reimbursed more than €10 million in total: Germany, Sweden, Norway, Ireland and Belgium.

Where those patients went is the second finding. Of the 2,266 reimbursements, 186 were for treatment in the United Kingdom under post-Brexit transitional arrangements. The remaining 2,080 break down by country of treatment as Spain 1,108, Poland 371, Lithuania 294, Germany 101, Latvia 54, Romania 45, Czechia 33, Hungary 18, Belgium 10 and small numbers elsewhere. More than half of Ireland's Directive traffic goes to one country.

The border is the part the European table cannot see. The Directive once carried Irish patients to private hospitals in Northern Ireland, an hour or two by road. It no longer does: "You can no longer use the CBD to access healthcare in the UK. This is because the UK left the EU on 31 December 2020." That traffic runs instead through a domestic arrangement, the Northern Ireland Planned Healthcare Scheme, which the HSE calls "similar to the Cross Border Directive" and which covers planned care bought from private providers in the North. It repays the lesser of what the patient paid there and the price of the same care in the Irish public system, capped for an outpatient appointment at €194 from 1 May 2023. Inference — a scheme created because the Directive stopped applying is not counted in the Directive's returns, and no published figure for its volume was found on this pass — which is not evidence that none exists. The consequence is that Ireland's best-measured outbound flow is the one that crosses a sea, and the one that crosses a field is the one nobody here can count.

The prices attached to all this are the Irish public system's own. The HSE's guide to the most common procedures under both schemes prices lens interventions — cataract surgery — at €1,171 as a day case, colonoscopy at €1,001 and gastroscopy at €726, taken from its 2024 activity-based-funding price list. Those are not what the operation costs in Belfast, Alicante or Vilnius. They are the ceiling on what a patient gets back.

Inbound is the short paragraph. In the same European return for 2024, 27 granted reimbursement requests across all reporting countries named Ireland as the country of treatment, against Spain's 32,495 and Germany's 19,719. Inference — that counts only patients who claimed the money back at home under the Directive and so misses anyone who simply paid an Irish private hospital, but the order of magnitude is the point: a country that sends 2,080 people abroad on that route receives 27 back on it. Ireland is in this directory because of the outflow.

Under the Cross Border Directive scheme the referral must come from "a GP or a consultant you see as a public patient"; the patient is treated in one of the 27 EU states or in Iceland, Liechtenstein or Norway, "must pay the provider" in full, and then claims back from the HSE at the Irish public price for the relevant diagnosis-related group — a code that fixes a single price for a category of care — or the amount actually paid, whichever is lower. Prior authorisation applies to almost nothing: Ireland has notified the Commission of one procedure only, Enzyme Replacement Therapy, and has received no prior authorisation request since 2020. What it runs instead is voluntary Prior Notification for inpatient episodes, which tells the applicant in advance what DRG code and what figure to expect. The Northern Ireland scheme works the same way across the land border, on the same referral rule and the same pay-first rule, against the same Irish price list.

The Treatment Abroad Scheme is the opposite shape. It covers planned treatment in the EU, EEA, United Kingdom or Switzerland on the E112 (IE) form, which is the S2 certificate; referral is only by a public hospital consultant currently treating the patient — "We do not accept referrals from GPs or self-referrals" — and the treatment must be "not available in Ireland, or not available in the time normally necessary to get it in Ireland". Where it is granted the states settle between themselves and no treatment invoice reaches the patient. Travel, accommodation and food are outside it.

As of 17 September 2026 the most recent NTPF figures are August 2026, published on 11 September, and the most recent European return is reference year 2024. The Northern Ireland scheme has been running since the Directive stopped applying to the United Kingdom.

Nothing here is legal advice and nothing here is medical advice. A reimbursement rate is not a price and a waiting list count is not a waiting time.