Written Answers. - Health Insurance Regulations.
Máire Geoghegan-Quinn
Question:
80
Mrs. Geoghegan-Quinn
asked the
Minister for Health
the number of patients suffering from psychiatric illness who will be affected by the changes in the numbers of days cover in the proposed new health insurance regulations.
[7870/96]
Tony Gregory
Question:
81
Mr. Gregory
asked the
Minister for Health
his response to a submission (details supplied) from the AWARE organisation regarding the regulations under the Health Insurance Act, 1994; and if he will make a statement on the matter.
[7889/96]
, Limerick East): I propose to take Questions Nos. 80 and 81 together.
The health insurance regulations were signed by me and laid before the House on 28 March 1996.
The regulations were framed in the context of the creation of an open single market in private health insurance. It is the objective of the EU's Third NonLife Insurance Directive that insurance undertakings authorised in one member state should be free to establish or provide services in any other member state. The EU Commission and I, as Minister for Health, want to see competition develop in the Irish private health insurance market.
The regulations, which were made pursuant to the Health Insurance Act, 1994, are intended to facilitate competition while protecting our core values of community rating, open enrolment and lifetime cover. Accordingly, these contain a variety of protections for the consumer within a competition framework. The regulations include a legally guaranteed minimum level of cover in respect of a variety of hospital and consultant in-patient, day-patient and outpatient services. Under the regulations consumers are entitled by law to a specific minimum level of cover under health insurance contracts which can be sold in an open competitive market here. Prior to this consumers had no such legal protection and were reliant on the customary practices, in a restricted market, of the country's sole provider of private health insurance to the general public.
Under the Regulations the minimum period of guaranteed cover in respect of private psychiatric in-patient care is 100 days in a year. Furthermore, I am committed to making provision, at an early date, for a further period of 20 days' day-patient care in private psychiatric hospitals. This compares to the 40 days in-patient cover which was the original proposal on psychiatric cover. Following an intensive consultation process, I was pleased to be able to respond positively to the concerns of the appropriate interests in regard to insurance cover and substantially increase the cover on the lines indicated. This compares very favourably with the position taken by insurers eleswhere who specifically limit, in some cases extensively, their exposure to risk in the area of psychiatric illness. It is the practice of foreign insurers to exercise pre-authorisation of admissions to psychiatric hospitals and to otherwise be in a position to significantly qualify the basis on which benefit may be payable. My Department is not aware of any other case internationally where providers of private health insurance contract to make available cover for a period of 100 days' psychiatric in-patient services without pre-certification and in an enviorment where the entire population is eligible for a free public psychiatric service.
The health research board's 1994 Report on the Activities of Irish Psychiatric Hospitals and Units provides statistical information on discharges and length of stay in private psychiatric hospitals. Of a total of 4,209 discharges in that year, 3,871, or 92 per cent, occurred within three months. A guaranteed minimum level of cover in respect of 100 days in-patient services in a year therefore represents a very significant protection for the consumer, particularly in the context of the operation of a free market and insurance practice in the area of exposure to liability for such cover. In addition to this there will be the minimum cover for day-patient services which I mentioned earlier.
Where circumstances arise that an insured person requires treatment in excess of 100 days, later to be increased to 120 days, in a year, it is open to him or her to avail of in-patient care in public psychiatric hospitals and public community-based facilities.
Prior to finalising the regulations I met representatives of the two major private psychiatric hospitals who welcomed the significant increase in the proposed minimum cover. I regret that the AWARE organisation did not consider it possible to accept the provisions of the regulations.
