andMr. Hogan asked the Minister for Health if his attention has been drawn to a newspaper report (details supplied) that hospital charges will be increased by nearly 50 per cent; and if he will make a statement on the matter.
8.
Ceisteanna—Questions. Oral Answers. - Hospital Charges.
7.
asked the Minister for Health if he is aware of a report that maintenance charges in hospitals will be substantially increased in the near future; and if he will make a statement on the matter.
9.
asked the Minister for Health if, in view of the widespread concern throughout the country and the inability of many people to meet the new hospital maintenance increases which could result in their postponing their hospitalisation, he will make a statement on the reasons for the increased charges; and if he will indicate what steps he has taken to ensure that these increases are not passed on to the public.
10.
asked the Minister for Health if he will make a statement regarding the increased maintenance charges in voluntary hospitals; if he is aware of the serious public concern at the amount of the increase; and if he will state the average annual increase which must be paid by a family of five (three children) contributing to the Voluntary Health Insurance Board to maintain their existing benefit levels.
With your permission, a Cheann Comhairle, I propose to take Questions Nos. 7 to 10 inclusive together.
I recently approved of increases in the payment by Health Boards for the maintenance and treatment of patients receiving services under the provisions of the Health Acts in hospitals other than those conducted by the boards. These adjustments are made periodically and are an essential feature of the financial administration of the hospital services. The additional expenditure involved for Health Boards in consequence of the current revision has been provided for in full in the grants payable from the Vote for my Department, and ratepayers will not have to bear any part of the increase.
My decision to increase the Health Board payments for Health Act patients does not apply to the charge which a hospital makes on self-paying patients; but to the extent to which the revenue deficits of voluntary hospitals are affected by the hospitals' income from all sources, the revision of such charges is a matter for consideration in the normal course of administration of hospital finances.
Prior to the current increase, from 1st April, 1972, the capitation rates payable by Health Boards to voluntary hospitals were last increased with effect from 1st April, 1970. The need for a substantial increase is largely the result of increases in staff costs in the course of the years 1971-72 and 1972-73. These increases added over £2.75 million to the total salary bill of the voluntary hospitals for the year 1971-72 as compared with 1970-71. The estimated further increases in 1972-73 is £1.75 million. There is thus an increase of £4.5 million in staff costs alone in the two-year period or 33? per cent. This increase is due in part to additional hospital staff, both in absolute terms and because of reduction in hours of work. A considerable proportion of the increased cost was due to much needed status increases in salaries and wages for nurses and junior medical staff.
The increase in the income of the voluntary hospitals which it is estimated will arise from the increase in capitation charges payable by Health Boards is £4 million. This is short by half a million of the increase in staff costs alone since the capitation charges were last adjusted; increases in other items in the same period are estimated at £2 million. As can be seen from the Book of Estimates for 1972-73, in spite of these increases in capitation rates, the Exchequer support for the Hospitals Trust Fund in that year will amount to £7.75 million by way of grant-in-aid towards the revenue deficits of these hospitals.
It will be clear to Deputies that in the matter of charges for hospital services, whether to Health Boards or individuals, the task of the Minister is to maintain a reasonable balance in the incidence of costs of a service which continues to be increasingly expensive. The acceleration of costs in the hospital services in recent years might be illustrated by the fact that over a period of four years from 1969 the over-all rate of increase in the cost of maintaining a patient in a teaching hospital has risen by more than double the rate of increase in the consumer price index. With the establishment of the Regional Hospital Boards, voluntary hospitals will be budgeting in advance of each year's expenditure and management studies will be promoted to ensure maximum efficiency.
Finally, I would like to refer to Deputy Desmond's specific question regarding the effect of an increase in hospital charges on the cost of insurance to cover a family of five. If there were to be an increase of £2 a day—which is the maximum involved in the recent revision—I am advised that the Voluntary Health Insurance premium for such a family, for semi-private accommodation, would need to be increased by about £10 a year; with tax relief this would be reduced to about £7. If the increased charge were lower than £2 a day, the increase in the premium, gross and net, would be correspondingly lower.
The Deputies are no doubt aware that the private hospitals not receiving Hospital Trust deficit contributions have had to increase their charges at intervals to keep pace with rising costs.
Would the Minister not agree that this exorbitant increase imposes an intolerable burden on those who are just outside the insurance limit? Would he not consider it more advisable that there should be an inquiry into the charges and the means of streamlining hospital services? Pending such an inquiry, does the Minister not consider he should not sanction any increase but should ensure that there be better diagnostic facilities available on an out-patient basis and thus prevent unnecessary hospitalisation, which is necessary in present circumstances? It would be much more advisable to have an inquiry into the matter and not allow the increases to take place.
The diagnostic services are increasing constantly. If the Deputy wants to ask a question about the number of out-patient consultants appointed in the last four years, he will find there has been a considerable improvement——
Would the Minister not agree——
I have not yet replied to the Deputy. At least the Deputy can be polite enough to allow me to complete my reply. The Deputy asked a number of questions. He will be aware that there are a number of people—some several thousand persons —who are insured manual workers who continue to have the benefit of the eligibility services above the income limit of £1,600. There are a number of people who are voluntary contributors to social insurance, having passed the limit of £1,600. The Deputy should be aware that under the Health Act those in the upper income group can have hardship contributions made available to them from the health boards if they can prove that a case exists for that. Finally, the Deputy might be aware of the recent arrangements made for income tax allowances. For example, in 1968-69, if one was to take someone with a wife and three children, whose earnings were £2,000, his income tax allowance would be £1,314. On hospital expenses of £600 he would have an allowance of £200 and the total income tax payable under those circumstances would be £170. In the current year, as a result of the budget, the same family would have to pay only £9 income tax after allowance had been made for income tax allowances and hospital expenses on which there is now no upper limit for income tax purposes.
Can the Minister state——
Does the Minister not realise that the increases widen the gap and make it more difficult with regard to Northern Ireland——
Deputy O'Connell should allow Deputy Hogan to put his question. Would the Deputy please behave himself?
May I ask the Minister why he did not advert to this substantial increase in hospital maintenance charges when his Supplementary Estimate was going through the House some weeks ago? Then we could have had an opportunity of discussing fully this involved question.
I am not responsible for the amount charged by voluntary hospitals to private patients——
(Cavan): Did the Minister know there would be an increase?
I can assure the Deputy that even after allowing for these increases, as before there will be an element of subsidisation from the Exchequer even for private patients who pay the increased charges.
In view of the unsatisfactory reply given by the Minister, I wish to give notice that I will raise this matter on the Adjournment.
The Chair will communicate with the Deputy.
Is the Minister aware that 350,000 contributors to the voluntary health insurance face minimum increases of 10 per cent in their premiums? The figure the Minister gave is an erroneous one. The Voluntary Health Insurance Board stated today that a married man with three children who wants semi-private cover needs to pay £8.88. Those people who are outside will face a further 10 per cent increase. Is the Minister aware that the Voluntary Health Insurance Board have stated that there will be a serious shortfall in benefit to the 350,000 contributors unless they immediately answer the advertisement which has been published in today's newspapers and which will run for a few days, and increase their units?
I have made inquiries about this and I am satisfied that the increases I have mentioned are increases that could be reasonably borne by those whose incomes have increased substantially since 1970. If the Deputy looks at the earnings increase and the increases of incomes generally since 1970 he will find that the increase in the amount of insurance that has to be paid, or even a larger amount, is reasonable under the circumstances.
Is 1970 ten years ago?
Is the Minister aware that there are many people who are not covered by voluntary health insurance as they are excluded from such cover because of their disease or illness?
I have already given an illustration of how they were helped by the income tax allowance——
The Minister referred to a person with an income of £2,000 and a hospital bill of £600——
The Deputy can apply the same calculations to other varieties of income and allowances. I have indicated to the House that under the Health Act there is a hardship clause by which people who are in the upper income group and who face excessive charges for any reason can get a contribution from the health board.
Does the Minister not agree that this is making the situation worse with regard to Northern Ireland? We are talking about putting our services on a par with the North but the reverse is taking place. We are widening the gap and making it much more difficult for people in the North to consider seriously any question of becoming united with us when our health services are so expensive and are such a burden on people.
The system in the North is entirely different from here; there is no comparison.
I am calling Question No. 11. We cannot debate this question all afternoon.
Would the Minister consider helping those people by using central funds and not ask those people to pay the increase?
That is a separate question.
We have a three-tier system in this country. All the statistics available to me show that the health of the people in this part of the country is as good as the health of those in the UK.
Can the Minister state why this was not disclosed when the Estimates were being prepared?
The hospitals had not worked it out.
(Interruptions.)
We are told some of the increases go back to 1970.
I am calling Question No. 11.
The House will have to accept my word that I did not know about the increases——
The Minister should have known. That is part of his job.
I am not responsible under the Health Acts for charges made to private patients.
(Interruptions.)
I have told Deputies that we cannot have a discussion on this question. I have called Question No. 11.
I have often heard the Chair correctly object to the lengthy questions from this side of the House. Is there no limit to the length of answers that may be given from the other side of the House? Must the time of the House be wasted by these long answers?
I am calling Question No. 11.