asked the Minister for Health the basis for his estimate of £1.8 million as the cost to the Exchequer of the proposals for free hospitalisation.
Ceisteanna—Questions. Oral Answers. - Free Hospitalisation.
17.
This estimate allowed for increased expenditure by health boards on their own hospital services and on their maternity services and the scheme of subsidies for expenditure on drugs, medicines and appliances. It also allowed for increased payments by way of capitation grants by health boards to voluntary hospitals. A rise in expenditure under subhead K.1 of the Vote for Health to meet deficits of voluntary hospitals was also allowed for.
The total of these elements, which included provision for increased remuneration, was £2.9 million. The deduction of additional revenue from health contributions and income tax— through some reduction in reliefs for voluntary health insurance—gives a net figure of £1.8 million.
Would the Minister not agree that a major element in the cost of these proposals is remuneration of consultants and that the discussions or negotiation with a view to fixing remuneration have not even started? Until he knows what the remuneration is likely to be and the basis on which it will be fixed, surely any estimate is purely guesswork.
Any estimate is purely guesswork.
Is the Minister telling the House that this estimate of £1.8 million is purely guesswork and nothing else?
It is the nearest estimate I can get at present and I think in all the circumstances it is reasonable.
We cannot have an argument about this matter.
Is the Minister aware that the medical profession estimate the likely cost of this at many times this figure of £1.8 million?
I suggest my estimate is as good as theirs.
The taxpayers have to pay for this and it is not good enough for the Minister to give a flippant answer like that.
Statements are not permissible at Question Time. Question No. 18 has been called.
I do not regard this matter with any flippancy but the Deputy must remember——
The Chair has called Question No. 18.
18.
asked the Minister for Health if it is intended that in future a person involved in a motor accident will receive free hospital treatment at the expense of the taxpayer; or whether the insurance company concerned, where liable, will be required to pay the full hospital costs incurred.
The removal of the limit for determining eligibility will not involve any change in the present arrangements for the provision of treatment for persons involved in road traffic accidents. Under the Health Services Regulations, 1971, a person is not entitled to hospital treatment at the cost of the health board for injuries received in a road accident except where the chief executive officer of the board is satisfied that the person has not received, or is not entitled to receive, damages or compensation in the nature of damages. Hence, in such cases the cost would be payable by the insurer.
Is the Minister aware that it seems to be rarely if ever the practice to enforce that and would he take steps to see that this is done in future?
I am not so aware, but this information has been communicated to the organisations catering for doctors and consultants and they are pretty satisfied. Was the Deputy asking me to make this known to the health boards?
I presume they are aware of it but it would be particularly important to have it enforced in view of the proposed extension of the hospitalisation scheme.
I am sure every health board are conversant with the Health Services Regulations Act, 1971 which says, in fact, what I have said in concise form in reply.
Is the Minister aware that insurance companies are paying only subsidised hospitalisation rates for people involved in accidents and that the State pays the rest? They will only pay the day rate per patient per bed and the State subsidises the balance whereas the insurance company should be compelled to pay the entire amount in motor accident cases. Would the Minister's Department look into that?
Yes, certainly.
19.
asked the Minister for Health the likely effects on the voluntary Health Insurance Board of the proposed free hospitalisation scheme.
I have consulted the Voluntary Health Insurance Board on the likely effects on the board's operations of extending eligibility for free hospital services to all sections of the community. The board consider that, while there will be some reduction in premium payments as a result of the introduction of this service, and there may be some falling off in the number of members covered, the viability of the board's operations will not be affected. The most pessimistic estimate by the board of the effect of the new arrangements on their business is a reduction of about one-fifth.
Could the Minister say how long it is since he consulted with the Voluntary Health Board?
The original consultation between my officials and the Voluntary Health Board was about last June. I had the same information conveyed to me about two weeks ago.
Is it the Minister's wish that the majority of people who are at present in the voluntary health scheme would remain in it and avail of private treatment even when the proposed scheme comes into operation?
That is entirely a matter for themselves but the indications so far as I can see are that they would take, if not full cover, some cover so that they would be able to avail of a private or semi-private ward with a subvention from the health authority.
The Minister, at a Press conference which he gave after the announcement of this proposal, suggested that people who are in the voluntary health scheme would be better advised to stay there and avail of private wards. Is that his considered view, that persons obtaining private treatment would be better off than those getting free public treatment?
Anybody who wants to avail of the facilities in a private or semi-private ward should stay in the voluntary health scheme.
Question No. 20.
Will this reduce or increase the waiting time for poor people entering hospital for treatment?
It will not.
If there is an increase in the number of people availing of hospital services——
The Chair has called Question No. 20 and Deputies on both sides of the House will please obey the Chair.
What we are trying to do will not make more people sick.
(Interruptions.)
The Minister is a bit edgy after Cork.
The Minister should have the figures available for this House.
20.
asked the Minister for Health what consultation he had with the medical profession before announcing his proposals on free hospitalisation.
The views of the medical organisations on the implications for them of a revision of the upper income limit for limited eligibility were obtained at a meeting on 11th June, 1973. It was agreed at that meeting that if the Government were to decide to abolish the income limit I would see representatives of the organisations again.
On 30th August, 1973, prior to the announcement of the Government's decision I met representatives of the medical organisations and informed them of the Government's decision. I also indicated agreement to early discussions on revised remuneration and conditions for hospital consultants.
In effect, is the position that the doctors were called in about one hour before the announcement was made and told what the Government were going to do? Does the Minister regard that as consultation?
As I said in my reply, I had a discussion with representatives of the two organisations on 11th June. I informed them that I would make a recommendation to the Government and as soon as the Government made a decision I would see them again. I saw them on 30th August and told them of the Government decision and I referred to the matters which they had raised in the previous discussion. There was no discussion as such on the second occasion I met the doctors. The doctors said their associations would consider the Government's decision. It is true that I thought the two associations should be told prior to publication of the announcement of the Government's decision.
I should like to ask the Minister if negotiations have yet begun and if not why. I do this in view of the fact that one of the medical organisations has been pressing for early negotiations on this matter.
This is so. Originally a working party was established for the negotiation of a new universal contract but as far as my information goes it is not considered now that that working party would be adequate or suitable.
Or acceptable?
The working party can only be established by agreement, I presume. There is a suggestion that there would be a new working party in view of the changed situation.
When is it proposed to set this up?
How soon will it be established?
I would say in the next few weeks.
Does the Minister realise these negotiations are likely to be very protracted and difficult? If it is proposed to have this scheme in operation by 1st April next should he not have a definite date now for the commencement of these negotiations?
I cannot tell the two associations when negotiations should be started. I will be in touch with the associations. My officials have already been in touch with the representatives of the associations with a view to establishing a working party and the commencement of negotiations as soon as possible.
We are making very little progress. I must call the next question.
One organisation is actually pressing the Minister's Department to have negotiations completed.
We have got to pass on from this matter. I am calling the next question.
I assured the two organisations on the 30th August that as far as I was concerned I would try to get that done as quickly as possible.
Does the Minister mean an association and a union?
The Chair has called the next question and must be obeyed in matters of this kind.
There are not two associations. One is an association and the other is a union.
I know that they are two different organisations; they are organisations catering for the medical profession.