| Verified against primary record | |
| Prior authorisation requests (2023) | None received; the system exists but was not used[1] |
|---|---|
| Scope of the authorisation system | A single procedure: enzyme replacement therapy[1] |
| Prior notification system | Voluntary, and limited to inpatient care[1] |
| Reimbursement requests (2023) | 2,422 received, 1,762 granted, 214 refused[1] |
| Of those granted, care in the United Kingdom | 225 cases: 223 in Northern Ireland and 2 in England, under post-Brexit transitional arrangements[1] |
| Average processing time | 51 days, against a 30-day limit[1] |
| National contact point | Cross-Border Healthcare Directive Department[2] |
| Independently reported | |
| EU patients using the Directive each year | About 200,000, under 0.05 per cent of EU citizens[3] |
| Bands apply only to the rows beneath them. All counts are claims by Irish insured persons for care obtained abroad and are not a count of foreign patients treated in Ireland. The granted and refused figures account for 1,976 of the 2,422 requests received, because the Commission records that requests may be decided in a later year. No typical cost range is given because no official Irish source publishes prices paid by foreign patients. | |
Medical tourism in Ireland is dominated by a single land border. Of the cross-border reimbursement claims Ireland granted in reference year 2023, 223 concerned care obtained in Northern Ireland and two in England, under transitional arrangements following the United Kingdom’s departure from the European Union. Ireland also operates a prior authorisation system that covers exactly one treatment and received no applications at all.
An authorisation system for one therapy
The Commission records that Ireland received no prior authorisation requests in reference year 2023, authorising none and refusing none, while noting that Ireland does operate such a system. Its only prior authorisation procedure is for enzyme replacement therapy.[1]
This is the narrowest authorisation regime recorded in the collection. The Directive permits authorisation for care involving an overnight hospital stay or highly specialised and cost-intensive infrastructure, for treatments carrying a particular risk, and for providers raising quality or safety concerns. Ireland has used that latitude to cover a single class of treatment for rare metabolic disorders, leaving everything else on the reimbursement route.[5]
Ireland also runs a prior notification system, which the Commission records as voluntary and limited to inpatient care. A notification requirement that patients may decline to use is weaker still than the notification systems operated in Estonia, Slovakia and Lithuania.[1]
The Northern Ireland border
Ireland received 2,422 reimbursement requests, granted 1,762 and refused 214. Of the granted cases, 225 related to care in the United Kingdom: 223 in Northern Ireland and two in England, under post-Brexit transitional arrangements.[1]
The contrast between those two numbers is the substance of Irish cross-border healthcare. Northern Ireland accounted for more than 99 per cent of the recorded United Kingdom cases, which is what a land border with a shared language and adjacent hospital catchments produces. Patient mobility under the Directive is predominantly between neighbouring territories, and Ireland has only one neighbour.[1]
Those arrangements are described as transitional. The United Kingdom’s departure from the Union removed the ordinary Directive route between Ireland and the rest of the United Kingdom, and the European Court of Auditors’ account of the Directive describes a system built for movement between member states, which Northern Ireland ceased to be part of.[3]
Ireland settled claims in an average of 51 days against a 30-day limit, placing it among the countries recorded as exceeding their own deadline, alongside Croatia, Cyprus and Sweden.[1]
The framework
Ireland’s designated national contact point is a dedicated Cross-Border Healthcare Directive Department, one of the few cases in which a state created a unit specifically for the function rather than assigning it to an existing insurance fund, ministry or agency.[2]
Under Directive 2011/24/EU the member state of affiliation must reimburse cross-border care where the treatment is among the benefits it covers domestically, capped at the level of costs it would have assumed and not exceeding the actual cost of the care received.[5]
Eurostat separately maintains a collection of hospital discharges of non-residents, with tables for in-patients, day cases, bed days and average length of stay, reporting country of residence where member states can supply it. Individual cell values for Ireland were not retrievable for this article.[4]
For scale, the European Court of Auditors estimated about 200,000 patients a year using the Directive across the Union, fewer than 0.05 per cent of EU citizens, with prior authorisation applying in around 1 per cent of cases.[3]
Limits of the evidence
These figures describe Irish patients obtaining care abroad, not foreign patients treated in Ireland, for which no official Irish count was located. The within-year counts do not close, since 1,976 of 2,422 requests are accounted for by the reported outcomes and the remainder fall to be decided later. The detail of the post-Brexit transitional arrangements is not set out in the source beyond their existence, so nothing is asserted here about their terms or duration.
See also
- Medical tourism in the United Kingdom, the destination of almost all recorded Irish cross-border care
- Cross-border healthcare for border communities, the pattern the Northern Ireland cases reflect
- Medical travel for rare diseases, the field Ireland’s single authorisation procedure covers
- Government-funded treatment abroad, the category these claims fall into
- Cross-border healthcare, the framework producing the Irish figures
References
- European Commission, Directorate-General for Health and Food Safety. Data on cross-border patient healthcare following Directive 2011/24/EU, reference year 2023. 15 May 2025. Verified against primary record: the report was opened and the Irish rows showing no prior authorisation requests received despite a system existing, the record that Ireland’s only prior authorisation procedure is for enzyme replacement therapy, the record that its prior notification system is voluntary and applies only to inpatient care, the reimbursement row showing 2,422 requests received, 1,762 granted and 214 refused, the breakdown of 225 granted cases as 223 in Northern Ireland and 2 in England under post-Brexit transitional arrangements, the 51-day average against the 30-day limit, and the statement that mobility mostly involves neighbouring countries were read directly. Retrieved 23 October 2026.
- United Kingdom government publishing service. EEA countries and contact points. Verified against primary record: the list was opened and the designation of a dedicated Cross-Border Healthcare Directive Department as Ireland’s national contact point was read directly, together with the different kinds of body designated by other states. The document does not state a publication date, which is recorded here as a limitation. Retrieved 23 October 2026.
- European Court of Auditors. Special Report 07/2019: EU actions for cross-border healthcare. 2019. Verified against primary record: the report was opened and the annual patient estimate, the share of EU citizens, the description of the Directive as governing movement between member states, and the share of cases requiring prior authorisation were read. Retrieved 23 October 2026.
- Eurostat. Hospital discharges and length of stay for inpatient and curative care (hlth_hosd), reference metadata. Last updated 15 December 2025. Verified against primary record: the metadata page was opened and the non-resident definition, the statement that country of residence is reported, and the list of non-resident tables were read. Retrieved 23 October 2026.
- European Parliament and Council. Directive 2011/24/EU, Chapter III, Articles 7 and 8. 9 March 2011. Verified against primary record: the chapter text was opened and the reimbursement rule in Article 7 and the three permitted grounds for prior authorisation in Article 8(2), including the overnight stay and specialised infrastructure condition, were read. Retrieved 23 October 2026.
Sourcing note: this entry uses only official sources. The share of United Kingdom cases accounted for by Northern Ireland is calculated directly from the two figures the Commission gives. Nothing is asserted about the terms or duration of the post-Brexit transitional arrangements, because the source records only that they exist. No official Irish count of foreign patients treated in Ireland was located, and no figure has been estimated.