asked the Minister for Health if he is aware of the widespread dismay caused by the recent exorbitant increases in hospital bed charges which he has sanctioned; and if he will make a statement on the matter.
Ceisteanna—Questions. Oral Answers. - Hospital Bed Charges.
5.
With the permission of the Ceann Comhairle, I propose to circulate with the Official Report a statement setting out the revised rates of maintenance charges which hospital authorities were requested to introduce with effect as from 1st July, 1975.
Maintenance charges were last settled in the case of health board hospitals in April, 1971, and for public voluntary hospitals in April, 1972. Since then the cost of hospital services generally has about doubled. Costs vary according to the type of hospital involved, for example, whether it is a teaching or a non-teaching voluntary hospital or whether it is a regional hospital or county hospital or district hospital of a health board. The charges also vary according to whether the patient is a person outside the existing limits or is a person with statutory entitlement to services who is exercising a choice to go to a private or semi-private ward.
In the case of the voluntary hospitals, most of the 1972 charges have been increased on average by 33 per cent to 40 per cent; in the case of the health board hospitals most of the increases on the 1971 rates were in the range of 50 per cent to 70 per cent. In other instances the revised charges range from £2 to £3 per day and represent only a relatively small part of the actual cost of the service provided.
I do not accept that the recent increases were exorbitant. In most cases they are far less than would have been justified by the increases in the costs that have taken place and do not go anywhere near meeting the full cost involved. In fact, the maintenance charges for private and semi-private wards represent only about half the cost of these services. The remainder is met from public funds. The proposals for increases were examined in great detail by the Prices Commission and the Minister for Industry and Commerce, acting on the advice of the commission, approved of the increases.
Because of the time which had to be expended in a careful examination of the proposals I was not able to give as much notice of the increases as it might be contended as desirable. If this has caused real inconvenience to any person I regret it. I note, however, that in a recent news release the Voluntary Health Insurance Board indicated that they are prepared to allow subscribers who may be underinsured to revise their insurance cover with effect from 1st July, 1975, and in advance of the ordinary renewal dates.
The following is the statement on charges for hospital services which hospital authorities were requested to introduce with effect from 1st July, 1975.
1. Persons without statutory entitlement to hospital services.
|
Private Ward |
Semi-Private Ward |
Public Ward |
|
|
£ |
£ |
£ |
|
|
Voluntary Hospitals: |
|||
|
Teaching |
10 |
9 |
8 |
|
Non-Teaching |
8 |
7 |
6 |
|
Health Board Hospitals: |
|||
|
Regional |
8 |
7 |
6.50 |
|
County |
6.50 |
6 |
5 |
|
District |
— |
— |
2.50 |
|
Orthopaedic Hospitals and Units after first four weeks (the rates for county hospitals apply for the first four weeks) |
4.50 |
4 |
3 |
2. Persons with statutory entitlement to hospital services who make private arrangements.
|
Private Ward |
Semi-Private Ward |
|
|
£ |
£ |
|
|
Voluntary Hospitals: |
||
|
Teaching |
4 |
3 |
|
Non-Teaching |
3 |
2.50 |
|
Health Board Hospitals: |
||
|
Regional |
3 |
2.50 |
|
County |
2.50 |
2 |
|
Orthopaedic Hospitals and Units after first four weeks (the rates for county hospitals apply for the first four weeks). |
2 |
1.50 |
It is at least something that the Minister admits the notice given in regard to the phenomenal increases was inadequate and has the good grace to apologise for that fact. Does he not recognise that these increases represent a further crushing burden for a very hard-pressed section of the community? In these circumstances did he not consider meeting these increased costs on the voluntary hospitals and the other hospitals from the Exchequer?
I would not agree to recommend to the Government that they should be met by the Exchequer. I did not apologise for the increases as the Deputy suggests.
For the inadequate notice.
Yes, I said that. I do not know whether the Deputy has figures but I should like to give him and the House some figures with regard to the cost and the maintenance charges. I said that increases had not been made in the case of health board hospitals from 1971 and in the case of the voluntary hospitals from 1972. In 1972, in voluntary teaching hospitals the average daily cost was £11. The present average cost is £20, an increase of 82 per cent.
In 1972, the average daily maintenance charge was £7. At present it is £10 which represents an increase of 42 per cent. While the increase in the average daily cost of maintaining a patient in a private room was 82 per cent the actual increase was only 43 per cent. I have similar figures in respect of regional and county hospital wards. In all the circumstances and in view of the increase in the average daily cost I think the new charges were justified.
The Minister adverted to the fact that these increases were sanctioned by the Prices Commission. Does he attach any significance to the fact that the reference to these increases was tucked away in a very obscure part of the appropriate Prices Commission's report and no reference whatever was made to them in the body of the report? Does he attach any significance to that attempted subterfuge by the Minister for Industry and Commerce? Furthermore, does he regard the Voluntary Health Insurance scheme as of the utmost importance and as a very successful scheme? In the circumstances, does he not think that in matters of this sort he should do everything within his power to enable the Voluntary Health Insurance Board to conduct their affairs as efficiently as possible? Does he not think that the way in which these increases were handled seriously disrupted the operations of the board and their planning, and caused considerable hardship and upset to those people who rely on the Voluntary Health Insurance Board to meet their hospital expenses?
I am not aware that these increases were tucked away so that they would not be noticed in the report of the National Prices Commission. There were consultations with the Voluntary Health Insurance Board ranging over months. The Deputy has probably read in the papers a news release to the effect that the 36 maintenance units which are now in operation were suggested by the Voluntary Health Insurance Board early in the year. After the increases were announced the board said a cover of 36 units was sufficient even to cover the new charges. Therefore, in those circumstances I do not think it can be said that I did not have due regard to the role which the Voluntary Health Insurance Board played in the hospitalisation of people in the private or semi-private wards.
The news release to which I referred from the Voluntary Health Insurance Board was dated 7th July, and this stated that current hospital charges meant that in future a patient occupying a private room in a voluntary hospital would require about 36 maintenance units to provide adequate cover. That was recommended about March or April. In public advertisements the Voluntary Health Insurance Board recommended that the number of units for maintenance would be 40. They did this in order to ensure that anybody going into a private ward would be adequately covered. Apart from that the Voluntary Health Insurance Board decided that those who did not have sufficient cover on 1st July could take out additional cover and that this would be retrospective as far as charges were concerned to 1st July.
It represented a considerable upset to the board and to the people. Would the Minister for Health tell us, in view of these staggering increases and the financial position which he has now revealed to us of these hospitals, if he still intends to present the charade of making hospital services free to the entire community, even to the wealthier sections? Does the Minister still intend to pursue, even on paper, the proposal to make the hospital services free to all the people?
This is getting away from the subject matter of the question.
It is my objective in any case. I do not believe these increases were staggering as the Deputy suggests. I believe they were justified.
If the Minister had to pay them he might have a different view.
Maybe I am lucky in that respect, but we all find these expenses are difficult.
Would the Minister confess to the House if this represents a further significant step in pursuit of his social philosophy of grinding the unfortunate middle class here out of existence?
That is a separate matter, and I am calling the next question.
In view of the extreme cost of hospitalisation would the Minister consider the further development of domiciliary care to obviate hospitalisation? In the case of geriatric treatment would the Minister see that an allowance is paid to those who care for elderly people at home, that an allowance is paid to such people as daughters or daughters-in-law who care for elderly relatives?
These are separate matters deserving of separate questions.
In order to obviate the cost would the Minister consider paying an allowance to those who care for relatives who would normally have to go into geriatric homes?
I do not think there is any difference of opinion between Members on the other side and me as far as keeping people out of hospital is concerned. I dealt with that at length during the debate on the Estimate for my Department. My object is the same as the Deputy's, to keep people out of hospital. I am examining the possibility of ensuring that allowances are paid where a person is cared for at home and not sent into hospital.