Vol. 530 No. 3
151 Mr. McGrath asked the Minister for Health and Children if medical card holders in publicly operated nursing homes are entitled to such hospitalisation free of charge; if the patients pension is assessed as means; and if a proportion of it is used for payment of hospital charges. [3550/01]
152 Mr. McGrath asked the Minister for Health and Children if medical card holders in privately operated nursing homes are entitled to such hospitalisation free of charge; if the patients pension is assessed as means; and if a proportion of it is used for payment of hospital charges. [3551/01]
153 Mr. McGrath asked the Minister for Health and Children the reason patients in privately operated nursing homes are not entitled to free hospitalisation under the free in-patient service scheme for everybody. [3552/01]
I propose to take Questions Nos. 151, 152 and 153 together.
Under arrangements introduced in June 1991 on foot of the Health (Amendment) Act, 1991, everyone regardless of income is eligible for in-patient services subject to statutory charges.
These services may be provided directly by the health board in one of its own hospitals, or in another publicly funded hospital, or by way of a contracting out arrangement between the health board and a private institution. Alternatively, one can opt for private treatment – all persons, including medical card holders, who opt for private treatment are liable for any expenses they incur.
Charges can be made under two sets of regulations in respect of long-stay or extended care. They can be made under the Health (Charges for In-Patient Services) Regulations, 1976, as amended by the Health (Charges for In-Patient Services) (Amendment) Regulations, 1987. These regulations enable charges to be made towards the cost of providing hospital in-patient services for persons with income who have been in receipt of such services for more than 30 days or for periods totalling more than 30 days within the previous 12 months. Persons with dependants are not liable for these charges. The legal basis for these charges is section 5 of the Health Act, 1947, which allows regulations to be made, and sections 51 and 53 of the Health Act, 1970.
Charges may also be made under the Health (Charges for In-Patient Services) Regulations, 1976, which allow for a charge towards the costs of in-patient services provided under section 52 of the Health Act, 1970, for a person with limited eligibility and without dependants who has been in receipt of in-patient services for 30 days.
Under the Health (Nursing Homes) Act, 1990, health boards are empowered to pay a subvention where a person has been assessed on the grounds of means and dependency, as provided for in the Nursing Homes (Subvention) Regulations, 1993 to 1998, which set down the requirements for this assessment. It is important to point out that, subject to a means test, a person will only be entitled to a subvention if they fulfil the dependency criteria laid down in the Subvention Regulations, 1993.
The Deputy will be aware of the shortcomings in the operation of the nursing home subvention scheme highlighted in the Ombudsman's recently published report and a number of measures have already been taken to deal with some of these problems. However, I am advised that the legal position with regard to an individual's entitlement to in-patient services is not at all as straightforward as the report contends. In particular, the Health Act, 1970, as amended, distinguishes between eligibility and entitlement, although the two terms are often used interchangeably. To be eligible means that a person qualifies to avail of services either without charge – full eligibility – or subject to prescribed charges – limited eligibility.
