Dáil Éireann Debate, Tuesday - 16 April 2024
672. Deputy Aodhán Ó Ríordáin asked the Minister for Health if he is aware of the shortfall between the cost of prosthetic limbs for amputees and the reimbursement from insurance companies; and what action he proposes to bring them in to line. [16145/24]
View answerThe Health Service Executive (HSE) provides a wide range of medical and surgical aids and appliances, including prosthetics, free of charge to eligible persons (such as medical card holders and people on the Long-Term Illness scheme) following assessment by a relevant health professional. These are provided through community services known as Community Funded Schemes and play a key role in assisting and supporting people to maintain everyday functioning, and to remain living in their homes and local community.
Amputees, whose amputation arose from either a traumatic or elective event, usually have their primary prosthesis fitted at the hospital where the surgery was undertaken. Subsequent prostheses are provided to eligible clients through the Community Funded Schemes. Rehabilitation services are provided by the National Rehabilitation Hospital (NRH) primarily at their site in Dun Laoghaire and augmented by a number of satellite clinics that they operate throughout the country. There are also a number of smaller services operated at regional level that provide assessment and fitting clinics along with prostheses at a local level.
The HSE Service Improvement Programme (SIP) has the aim of improving the equity of access, value for money, and functional processes of the Community Funded Schemes through the establishment of national guidelines for the provision of medical and surgical aids and appliances. The HSE advise that currently funding of prosthetics is undertaken through the Community Funded Schemes based on an individual's clinical needs and their eligibility status. A priority for the HSE SIP in 2024 is a review of the existing provision of limb prosthetic services.
People who cannot, without undue hardship, arrange for the provision of medical services for themselves and their dependants may be eligible for a medical card. In accordance with the provisions of the Health Act 1970 (as amended), eligibility for a medical card is determined by the HSE. Medical card eligibility is primarily based on an assessment of means and is not granted on the basis of any particular condition.In certain circumstances, the HSE may exercise discretion and grant a medical card, even though an applicant exceeds the income guidelines, where he or she faces difficult financial circumstances, such as extra costs arising from illness. The HSE afford applicants the opportunity to furnish supporting documentation to determine whether undue hardship exists and to fully take account of all relevant circumstances that may benefit them in assessment, including medical evidence of costs and certain expenses.
Ireland has a voluntary private health insurance market which operates under the principles of community rating (including lifetime community rating), open enrolment, lifetime cover and minimum benefits. The Minister for Health regulates the Private Health Insurance Market in Ireland. The Health Insurance Act 1994 (Minimum Benefit) Regulations 1996 require insurers to offer a minimum level of cover to every insured person.
The Minister does not have a role in the commercial decision-making of any private health insurer. Private Health Insurance companies operate as commercial entities in a competitive private health insurance market. Beyond prescribing under the Regulations the minimum level of coverage that health insurers must provide, the Minister is not in a position to direct any insurer to provide cover for any particular procedure or service, or direct how that cover is to be provided.
The Minister recommends that individuals seeking to utilize their health insurance, check with the relevant insurance company in advance of using a service. This is to ensure that their policy provides sufficient cover prior to using a service in case they are not covered.
