Jan O'Sullivan
Question:131 Ms O'Sullivan asked the Minister for Health and Children his views on the recent ESRI report entitled Private Practice in Irish Public Hospitals; and if he will make a statement on the matter. [24545/00]
Written Answers. - Publication of Reports.
Olivia Mitchell
Question:155 Ms O. Mitchell asked the Minister for Health and Children if he has considered the ESRI report entitled Private Practice in Irish Public Hospitals; and if he will make a statement on the matter. [24493/00]
I propose to take Questions Nos. 131 and 155 together.
My Department commissioned the ESRI to carry out a research study on private practice in public hospitals in May 1998. On 19 October last, the ESRI published its report, Private Practice in Irish Public Hospitals by Dr. Brian Nolan and Miriam Wiley. The report assesses the extent of private practice within the public hospital sector, the characteristics of the case-mix being dealt with, and the costs associated with provision of that care. The report also considers the adequacy of the arrangements currently in place regarding equity of access for public patients, which involve, inter alia, the designation of beds as private versus public and the monitoring of their use.
Since the early 1990s, most beds in public hospitals have been designated as for public or private use. About 20% of in-patient beds in acute public hospitals are currently designated as being for private patient use. The report shows that, of the total number of public bed days used, approximately 6% were used by private patients and that about 23% of all in-patient bed-days spent by private patients in public hospitals were in beds designated as public. In addition, the report also shows that there is a crossover of slightly lower absolute volume in the other direc tion, that is of public patients into private beds. The authors suggest that improvements to the reporting and monitoring of the arrangements could be piloted in hospitals where crossover is most prevalent. The report states that the main factor identified by hospital management as leading to private patients being accommodated in public beds was admission through accident and emergency departments. This largely reflects the need to accommodate patients in the most appropriate available bed, irrespective of its designation. Nonetheless, the study shows that the throughput of patients is consistent with public-private bed designations. The public private mix in public hospitals is under continual assessment by my Department to ensure that the best possible service is available to all patients, but particularly the public patient. This assessment includes monitoring of the bed designation system whereby the approval of the Minister for Health and Children must be obtained by public agencies for any increase in the designation.
In examining the extent and cost of providing private care in public hospitals, the study found that the cost of provision of private care in public hospitals substantially exceeds the current level of charges for such care. About one quarter of the direct cost of providing in-patient care in public hospitals was attributable to private patients, accounting for about £130 million in 1996. This was about twice the income from charges for private accommodation. As indicated in the White Paper on Private Health Insurance, the Government is committed to moving towards the full economic costing of private beds in public hospitals. The progression towards more economic pricing will be determined in a way which is sensitive to maintaining stability in the market for private health insurance.
The report finds that there are pressures on the system as a whole and indicates that changes in the structure of incentives facing hospitals, consultants and insurers could significantly alter the nature of the regulation required to promote equity of access. This Government has recognised these pressures and is addressing them on a number of fronts. In particular, I have initiated a study of bed capacity in response to commitments in the Programme for Prosperity and Fairness. This study is examining both acute and non-acute beds numbers and will deal with issues relating to bed numbers throughout the public system.