Increases in charges for in-patient services and attendance at accident and emergency departments, from which medical card holders are exempt, will take effect from 1 January 2004. The public hospital statutory in-patient bed charge will be increased by €5 to €45 per night, subject to a maximum payment of €450 in any 12 consecutive months. Attendance at accident and emergency departments is subject to a charge if the patient does not have a letter of referral from a general practitioner. This charge, which applies only to the first visit in any episode of care, will be increased by €5 to €45. In addition to the above statutory charges, the charge for private or semi-private accommodation in a public hospital will increase by 15% from 1 January next. The new charges are as follows: