asked the Minister for Health if he is aware that the maximum charge of 10/- per day payable for hospital treatment by non-medical card holders is regarded by some health authorities as an automatic charge in the vast majority of cases, and, if so, whether he will state what steps he proposes to take to deal with the matter.
Ceisteanna—Questions. Oral Answers. - Cost of Hospital Treatment.
I presume the Deputy appreciates the distinction between Section 15 and Section 25 of the Health Act, 1953.
An eligible person availing of services in a private hospital or nursing home of his own choice, or in a public hospital of his own choice in which he is not deemed to be availing of services provided by the health authority, is a Section 25 patient and under that section a health authority is liable to the hospital or home only for capitation charge normally paid to public hospitals for similar services, less 10/- a day. The deduction of 10/- a day is statutory and mandatory.
Where a patient is admitted to a health authority institution or is sent to an extern public hospital by the health authority or is deemed to have been so sent to such extern public hospital (as applies fairly widely in Dublin and Cork), Section 15 applies. Nothing in the Act, in the regulations made under it, or in the instructions issued by my Department gives any grounds for the automatic imposition of the maximum charge of 10/- a day on such of those patients as are not, prima facie, entitled to completely free service. I am aware that a few health authorities have tended to impose the maximum charge in the first instance, subject to review later on representations made by or on behalf of the patient.
Does the Minister think it is a good practice to charge the maximum in the first case and then leave it the responsibility of a public representative to endeavour to get it reduced? Would it not rather be the responsibility of the investigating officer of the local authority to make the proper charge, in the first instance?
That raises a question of local responsibility. I am not responsible for the details of the local administration of this Act. The local authorities are and, of course, their officers. Each local health authority must determine for itself which system is best suited to its use.
The Minister knows that members of local authorities have no say at all in the matter. The local health authority determines and operates the policy. The policy as operated by most health authorities is most objectionable and is not the policy which was visualised when the Act was being passed.
Is the Minister aware that persons have been refused medical cards, on the grounds that they are working and have an income of a figure which does not induce the local authority to grant them a card; but that when these people are ill and consequently receiving no pay, they are obliged to maintain themselves, their wives and children, on a maximum rate of social welfare benefit of 61/- a week? Because of the fact that they did not hold medical cards, the local authority is demanding payment of 10/- a day from such persons, most of whom are unable to pay. Would the Minister cause some inquiries to be made as to what the general practice is among local authorities, so as to bring order out of chaos?
That is a chaotic supplementary. There is no use trying to paint a very black picture like that.
It is true.
I listened to the Deputy while he was expanding himself at length; perhaps he would now listen to me. No person is compelled to pay 10/- a day who is not able to do so.
It is being demanded of them.
It is another thing to collect it, and no person is asked to pay it who cannot pay. At one moment, the Deputy is clamouring about the cost of the health services and now he is trying to push them sky high.
There is always chaos where you are.
You have almost killed the Labour Party with those tactics.
The conversion of the Minister for Health did not last long.