Billy Kelleher
Question:14. Deputy Billy Kelleher asked the Minister for Health his plans to review the Health (Amendment) Act 2013, specifically in respect of its impact on the hospital sector. [12346/17]
View answerWednesday, 8 March 2017
Questions (14)
Oral answers (7 contributions)
Deputy Billy Kelleher has 30 seconds to introduce his question if he so wishes - or does he wish to catch his breath?
I am in training so my oxygen levels are not too bad.
Does the Minister have any plans regarding the Health (Amendment) Act 2013, specifically in respect of its impact on the hospital sector and the concerns about the treatment of private patients in public hospitals? I know he has made an announcement since I tabled the question.
I thank Deputy Kelleher for this question. I acknowledge the Deputy has raised the issue with me previously in the Oireachtas Committee on Health and when we were considering the Health Insurance (Amendment) Act. I acknowledge his interest in the issue and wish to put a little information on the record of the House on the policy rationale behind this when it was originally put in place.
As the Deputy knows, although a proportion of activity in public hospitals involves the provision of care to private patients, the core purpose of our public health system is obviously to provide services for public patients. Government policy is to ensure that there is equitable access for public patients, that the proportion of private activity is appropriately controlled and that the costs of provision of services to private patients are recouped by public hospitals. It is important to note that when patients are admitted to hospital, they can choose whether to be treated as private or public patients.
The Health (Amendment) Act 2013 provided for the charging of all private inpatients. The Act addressed a situation identified by the Comptroller and Auditor General in his 2008 report whereby when a private inpatient was accommodated in a public or non-designated bed, no private inpatient charge applied. The report of the Comptroller and Auditor General noted that in 2008, 45% of all private inpatient throughput was not the subject of a maintenance charge because the patient was accommodated in a designated public bed. A further 5% was not charged for because the patient was accommodated in a non-designated bed, with the result that only 50% of private inpatient throughput gave rise to any maintenance charge at all. This was despite the fact that due to treatment costs, the type of room in which a patient is accommodated is by no means the major contributor to the overall costs of a hospital stay.
The absence of a maintenance charge in such instances represented a significant loss of income to the public hospital system and to taxpayers - I think this was generally accepted by many parties at the time - and was an indirect subsidy to private insurance companies, which cover most private patients. The additional income generated as a result of the enactment of the 2013 legislation is a key element of the funding to the public hospital system and any curtailment of this funding stream would put pressure on the taxpayer to maintain services.
I intend to review this, as the Deputy knows, and I will outline in my next response what I intend to do in this regard.
I welcome the fact that there will be a review, which we requested. There are concerns about this. It has been brought to my attention by some health care providers in the private sector that there is now competition in certain areas in trying to attract private patients and treating them on public beds. The concept of the 20% designation in public hospitals with treatment of private patients was originally a historical hangover from the time when it was a sweetener given to retain consultants we were unable to pay to keep them in service. However, subsequently, this has been breached continually, and it is not just me saying this. The bottom line is that Mr. O'Brien, the director general of the HSE, said that the 2013 Act has made a farce of the application of the rules restricting the level of private practice senior doctors can carry out in public hospitals. In an e-mail to the Minister's predecessor, the director general said large voluntary teaching hospitals were in some instances breaking the rules in how they went about recruiting consultants in the context of attracting and being able to guarantee that more than the 20% of private patients would be treated in public beds. Overall, we could now have private patients receiving preferential treatment, and more of them receiving preferential treatment ahead of public patients, to bolster hospital budgets.
That is absolutely not the policy intention, and Deputy Kelleher's assertion in this regard is one of the reasons I have instructed my Department to carry out a review. I have asked the Department of Health to conduct an analysis of trends in private activity in public hospitals since the Health (Amendment) Act commenced in 2013 and I intend then to review policy changes at that stage as well. As the Deputy was already aware when he raised this important matter with me at the Oireachtas health committee, I have undertaken to share this analysis and policy review with him when it is completed. My concern is not for the health insurance company but for the impact on premiums, which I know is the Deputy's concern as well. However, health insurers have expressed some important and legitimate concerns about the use of the private insurance patient form at a hospital level, in particular the manner in which patients are being requested to waive their right to be treated as public patients. It is accepted that there is a need for a consistent and clear approach at hospital level as to how the private insurance patient forum is presented to patients. In this regard, the HSE and the insurance industry will now meet. They have started an engagement, a series of meetings about this, to consider how the forum may need to be reviewed and in what circumstances it should be used. If a vulnerable sick patient is on a hospital bed or waiting in an emergency department, merely waving a form at him or her is not appropriate; there needs to be a clear and consistent protocol in place.
One should never ask the fox to carry out an inspection of the fence around the hen house, but that is what the Minister is doing in respect of the Department of Health on this occasion. It is a policy decision of the Department of Health to bring forward the 2013 Act, which allows for a designation of all beds in public hospitals for private patients. There is no doubt, even in the context of budgets being forced on hospitals, that there are now stretched budgets, which have effectively been put in place to force hospitals to maximise the number of private patients going through their hospitals for billing purposes and to bolster budgets. Stretched budgets are in their stated policy. We have asked all the hospitals about this but they all deny that this is what a stretched budget is. However, we know for a fact that the stretched budget primarily entails private patients being treated in public hospitals, and there is concern about this. I do not have any truck with the private health care providers; my representation here is on behalf of public patients who are potentially waiting longer to access treatment because beds are full of private patients in public hospitals.
I accept the Deputy's bona fides on this but he must also accept that the 2013 legislation came from the Comptroller and Auditor General’s report of 2008, which pointed out that there was a significant lacuna in the law, which was making it effectively impossible for up to 50% of any potential charge to be collected by the public health service. We would all share the view that the priority must be to invest in the public health service. If there was a possibility that private health insurance companies were not picking up their portion of the tab, that needed to be addressed legislatively and that was the decision of these Houses at the time.
The question that now arises is whether the policy is being correctly implemented, whether the way forms are administered in hospitals regarding waiving a patient’s right to be treated as a public patient is consistent and co-ordinated across the hospital system. From talking to the insurance industry I do not believe it is. That is why I have asked the HSE to meet the insurance companies, hear their concerns and come back with a set of proposals on that. It is why I have asked the Department to carry out an analysis and review and why, very much to protect the Deputy from the fox, I intend to share that review with him.