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"You organise your own appointment and choose your own doctor," says Donohoe, who adds that the scheme covers both private and public hospitals.When the operation has taken place you submit your invoices, receipts and proof of travel," she explains, adding that shopping around is recommended, as more reasonably-priced treatment is available in countries like Germany, France, Poland or Czechoslovakia.This time last year, pensioners Joe and Mary Bonallie were in severe pain - Joe, who has osteoarthritis, needed a hip replacement, while his wife Mary was in agony from carpal tunnel syndrome in her left hand."I had osteoarthritis for several years and in recent years it got very bad."The programme worked extremely well and the HSE were very helpful.I'd recommend it." He adds: "You have to have a referral letter from your doctor."I thought patients had to be on a public waiting list; I thought that to avail of the programme you had to be in the system, on a waiting list and I wasn't aware that we as GPs could refer someone," he said, adding that he now has a "number of patients" in the CBD system for issues like hip and knee replacements, and nose and throat problems.

She saw her GP about the hand in December 2016 and was put on a waiting list for further investigation. At the end of June 2017, Mary applied to participate in the CBD initiative.

Many patients will use personal savings, a credit union loan or a mixture of both to fund the up-front payment to the hospital in question.

If patients need to take out a loan, the HSE will provide a letter of prior authorisation, stating that the patient is eligible for reimbursement: "There's no waiting list - once people have the referral letter they can organise care abroad and typically, for example with an operation such as a hip replacement, this operation can be organised within a month.

Other reasons for low take-up include a belief that the scheme is "too good to be true", and a significant lack of awareness about it, both within the general public and amongst GPs, she says, even though the service has written to every GP and every consultant in the country to inform them about CBD.

This concern is underlined by Dr Andrew Jordan, Chairman of the National Association of GPs, who said that in July the organisation announced its intention to undertake an information drive highlighting the benefits of the Cross Border Healthcare Directive to members and patients.


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