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"I got a referral letter from my GP to Kingsbridge Hospital and was accepted for an operation for carpal tunnel." The operation was carried out last July, two weeks after she had initially contacted the hospital. I had to pay stg£950 to the hospital and I am now waiting to be reimbursed by HSE."A few days after that operation I got a letter from the HSE offering me an appointment just to have my hand checked out - for June 2018!"You organise your own appointment and choose your own doctor," says Donohoe, who adds that the scheme covers both private and public hospitals.

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.

I got that from my doctor, who was very interested in hearing about the directive." His wife Mary (75) was similarly delighted with her experience of the CBD. It has been bad for the last few years, but it got even worse over November and December 2016," she recalls.

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.

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