asked the Minister for Health if free choice of hospital is available to holders of medical cards to all approved hospitals for the health area in which they live or become ill.
8.
Ceisteanna—Questions. Oral Answers. - Health Services.
7.
asked the Minister for Health if free choice of hospital is available to all those who are covered for free hospital treatment under the Health Contributions Act, 1971; and if he will state the position of patients who wish to have private or semi-private treatment.
With your permission, a Cheann Comhairle, I propose to take Questions No. 7 and No. 8 together.
There is no distinction, as far as eligibility for hospital services is concerned, between medical card holders and persons coming within the scope of the Health (Contributions) Act, 1971. Both groups are entitled to free treatment in a public ward of a health board hospital in the area in which they live. If the eligible patient is sent with the approval of the health board to a voluntary hospital within the area or outside of it, or to a health board hospital in another area, he is also entitled to free treatment in a public ward in the hospital to which he is sent. In some health board areas where a substantial part of the service is provided in voluntary hospitals the health board operate a "deeming" arrangement which dispenses with the need for specific approval to admission in each case.
Where an eligible patient chooses to enter a public ward of a voluntary hospital, otherwise than under these approved arrangements, he would be liable for a charge of 50p per day by the hospital.
An eligible patient who chooses to enter a semi-private or private ward of a health board hospital is liable for a charge of 50p or £1 per day respectively. If he is admitted as a private patient of a hospital consultant, he would in addition be liable for the consultant's fee.
If the eligible patient is admitted to a semi-private or private ward of a voluntary hospital or to a private nursing or maternity home, the health board will make a contribution towards the cost of the patient's maintenance. The amount of the contribution varies between £1.74 and £3.52½ per day according to the type of institution involved. The patient in such a case is liable for all charges, including doctors' fees, over and above the contribution made by the health board.
9.
asked the Minister for Health if he will exempt from the payment of £7 per annum self employed persons who are already adequately covered under the VHI scheme or any other such scheme.
I would not be justified in exempting such persons as they would still be legally entitled to the range of health services for which other people with limited eligibility were obliged to pay the contribution. In particular, they are entitled to maternity services, which are not normally covered by voluntary health insurance. It is important to note, too, that a health board's commitment to the provision of hospital services for an eligible person is not limited in regard to duration of treatment or medical history. The Voluntary Health Insurance Board's services are of necessity limited in these respects since the board must have regard to actuarial principles.
As free public ward hospital services are provided by the health boards for persons with limited eligibility, such persons need take out voluntary health insurance only if they do not wish to use these services, preferring instead to make private arrangements. Where such a person makes such arrangements, his limited eligibility gives him a right to a subvention from the health board towards the cost of his care. This means that he can get full cover by taking out a modified policy with the Voluntary Health Insurance Board which is less expensive than that required by a person with no eligibility under the Health Acts.
Is the Minister not compelling these people to pay twice?
No. I have indicated to the Deputy in my reply that the person concerned can take out a modified policy with the Voluntary Health Insurance Board which is less expensive than that required by a person with no eligibility under the Health Act. Part of the cost of his hospital treatment is paid for him by the health board because he is a person with limited eligibility who has made a contribution of £7.
Is it not true that people who are covered by this £7 and who are already paying into the voluntary health insurance scheme are in the middle income group and this group are already hit hard enough without having this extra burden imposed on them? If they are paying voluntary health insurance could they not be exempted from the contribution of £7?
I have already replied to the Deputy. Perhaps she would be kind enough to read the reply and particularly the last paragraph, and if she has any further observations to make, she can ask another question.
Can the Minister say, where a number of contributors are already paying into the voluntary health insurance scheme and have, in fact, raised their contributions recently, why they are still being requested to pay £7 even though they are covered by the voluntary health insurance scheme?
Increased contributions to the Voluntary Health Insurance Board were required because of the increasing cost of hospital treatment. I still say that the last paragraph of my reply indicates the position. People who wish to do so can modify their policy with the Voluntary Health Insurance Board to allow for the fact that part of their service is paid for by the health board. The extra money they pay to the Voluntary Health Insurance Board is to ensure them an improvement in the type of accommodation in which they are placed. That has always been the case. There has been no change. I do not honestly see any reason why they should not pay the £7 contribution a year since they are, in fact, looking for better accommodation in the ordinary way as limited eligibility patients.
Does the £7 not cover persons other than those insured under the Voluntary Health Insurance Board?
The £7 covers all those with limited eligibility, that is to say, persons who have not got medical cards, persons who have less than £1,600 a year or are automatically insured for social welfare purposes and farmers with valuations under £60. Farmers with valuations under £60 who can prove that their income is inadequate can also be medical card holders.
Mr. Burke
Have they got a free choice of doctor and hospital for this £7 contribution?
The Deputy should read the reply to my question to Deputy Dr. Gibbons.
Question No.10.
In point of fact they have not.
Surely the Minister——
I have called Question No. 10. We cannot discuss this one question all evening. I have called Question No. 10.