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Seanad Éireann debate -
Thursday, 18 Jul 2013

Vol. 225 No. 4

Health (Amendment) Bill 2013: [Seanad Bill amended by the Dáil] Report and Final Stages

I welcome the Minister of State, Deputy White, to the House. This is a Seanad Bill which has been amended by the Dáil. In accordance with Standing Order 118, it is deemed to have passed its First, Second and Third Stages in the Seanad and is placed on the Order Paper for Report Stage. On the question, "That the Bill be received for final consideration," the Minister of State may explain the purpose of the amendments made by the Dáil. This is looked upon as the report of the Dáil amendments to the Seanad. For Senators' convenience, I have arranged for the printing and circulation of the amendments. The Minister of State will deal with the subject matter of the amendments in each group and I have also circulated the proposed grouping in the House. A Senator may contribute once on the grouping and I remind Senators that the only matter that may be discussed are the amendments made by the Dáil.

Question proposed: "That the Bill be received for final consideration."

The first grouping takes in amendments Nos. 1, 3 and 10. Section 2 of the Bill provides for the commencement of the Bill's provisions and amendment No. 1 made by the Dáil related to the commencement provisions in respect of the private inpatient charge, together with technical amendments regarding other commencement provisions. To briefly summarise the technical changes to section 2, amendment No. 1 included a provision to commence, upon enactment of the Bill, Part 1 and sections 5 and 14, in addition to section 6 and most of section 7. Other sections or subsections of the Bill shall be commenced as appropriate by way of commencement order.

As regards the private inpatient charge, sections 13 and 15 to 17, inclusive, all require co-ordination in the commencement. As a result of discussions the Department has had with the private insurance industry in order to agree a phasing in of charges for all private patients, including those occupying public beds, the Minister has decided to implement these charges from 1 January 2014 to ensure the agreed additional revenue is realised. As a result, the hospital income will be received in the latter eight months of 2014 rather than in 12 months, based on an implementation date of 1 September 2013.

The rates included in the legislation are set at the level to raise an additional €30 million in hospital revenue in 2014. This phasing is intended to enable the insurance market to adjust to the new charges without destabilising impacts. It will also allow for assurances to be provided to insurers that the additional revenues raised in 2014 will amount to €30 million in the calendar year. The Minister will keep rates under review to deliver the targeted revenue in 2014, as well as for the phasing in over future years.

As a result of this Bill, the hospital charge for a private day-case patient will be reduced from €828 to €407 in a Category 1 hospital, specified in the Fifth Schedule to the Health Act 1970. The daily charge for a private patient accommodated overnight in a multi-occupancy room in a Category 1 hospital will be €813. Currently the equivalent charges applied to a patient in a semi-private bed come to €1,008. To support this phasing approach, the private health insurers have confirmed their commitment in principle to continuing this year's process of payments to public hospitals in respect of private patients who have already been treated, as well as their commitment to participating in the initiative to be chaired by Mr. Pat McLoughlin that will address costs in the private health insurance industry to support the ongoing sustainability of the market.

Amendment No. 3 passed by the Dáil is purely technical in respect of section 9(c)(i), which is unchanged, apart from syntax and numbering, from section 9(c) as initiated. Regarding Dáil approval of the insertion of section 9(c)(ii), it has always been the case that where a person "does not avail of" some part of inpatient services under their full or limited eligibility, then under section 52 of the Health Act 1970 they are "deemed not to have full or limited eligibility, as the case may be, for those in-patient services", and may therefore be charged accordingly. The insertion of "waives his or her right to avail of, some part of those services”, mirrors the language in section 13 of the Bill and reflects the freedom of choice that patients currently have to access private care if they so wish.

I welcome the phasing in of these measures. It is important that the insurance industry is given time to respond to these changes and I welcome the way the Minister of State and departmental officials have approached this matter. It is a welcome development.

Some of these regulations seem to assume that it is a person from Mars who has a VHI subscription. We also have entitlements as taxpayers and I ask that this be borne in mind. I agree with Senator colm Burke that doing it on a more gradual basis is to be commended. People can be members of two schemes. Are we saying that a person with a VHI subscription must waive all entitlements that he or she has as a taxpayer and a citizen? I am glad the Minister of State is trying to juxtapose the two in a different manner than was originally intended, which I welcome.

I call on the Minister to speak on the second grouping, which takes in amendments Nos. 2 and 9.

Amendments Nos. 2 and 9 were made in the Dáil to clarify the current situation that maternity services for women are provided by or on behalf of the HSE, both in a hospital context and in a community or home setting. This is in line with current practice in hospitals and in the community. The majority of women choose to have their babies delivered in hospitals. Therefore, it is important to be clear that the HSE is in a position to provide this service. Amendment No. 2 provided this clarification in respect of inpatient services.

We will move on to third group which deals with the Schedules and the subject matter of amendments Nos. 4 to 8, inclusive, and 11 to 16, inclusive.

Amendments Nos. 4 to 8, inclusive and 16 relate to the deletion of section 18 and the Fourth Schedule to the Bill, and consequential amendments to delete the reference to the Seventh Schedule in section 13. These deletions were necessary following confirmation by Swinford District Hospital that it does not have any patients for whom charges payable in respect of inpatient services provided under section 55 of the Health Act 1970 apply. No other hospitals have been identified by the HSE as being in this category, reflecting a change in hospital activity over many decades whereby less complex and intrusive care is provided in local hospitals and units closer to the patient's community, and more complex care is provided in hospitals that are more appropriate in terms of specialties and quality and safety.

Amendments Nos. 11 to 15, inclusive, were technical amendments relating to corrections to the names of Connolly hospital, Sligo General Hospital and St. Luke's Hospital in Kilkenny, and to the addition of Our Lady's Hospices in Blackrock and Harold's Cross, Peamount Hospital and St. Vincent's Hospital, Fairview, to the list of institutions that may apply the private inpatient charge.

Sitting suspended at 2.25 p.m. and resumed at 3 p.m.

Question put and agreed to.
Question, "That the Bill do now pass," put and agreed to.