Dermot Fitzpatrick
Ceist:347 Dr. Fitzpatrick asked the Minister for Health if he will make a statement on the new health eligibility arrangements included in the Programme for Economic and Social Progress.
Written Answers. - Health Eligibility Arrangements.
Bernard Allen
Ceist:348 Mr. Allen asked the Minister for Health if he proposes to introduce a scheme whereby everybody will be entitled to full hospital treatment in a public ward, including access to consultants, irrespective of income in the near future.
I propose to take Questions Nos. 347 and 348 together.
New arrangements for eligibility for public hospital services were announced in theProgramme for Economic and Social Progress. The relevant extract from the programme is set out in the addendum below. The principal changes are the abolition of the income limit for Category 2 eligibility, so that all patients will now be entitled to avail of consulant care as a public patient, and the introduction of restrictions on the access of private patients to public beds.
The measures were recommended by the Commission on Health Funding and by the National Economic and Social Council, and were then agreed in the context of the discussions between the Government and the social partners on a new programme. The measures will go to rectify a number of anomalies identified by the commission which arise in determining eligibility for hospital services cards.
The new arrangements for hospital care have given rise to some misleading comment, and it is important, therefore, to make clear exactly what they involve: everyone, regardless of income, is already entitled to a public bed as a public patient, and this will not change. The hospital system will provide for the same number of people; at present, any public patient whose income is above £16,700, or who is dependant of a person with such income is liable for the professional fees of each consultant involved in his or her care. From 1 June next, those who wish to be public patients will no longer be liable for consultants' fees. This will greatly facilitate the management of hospital services by clearly identifying, for the first time, public and private patients; the availability of public beds for public patients will be increased by changing the present arrangements under which private patients are entitled to avail of public beds. New arrangements will be phased in under which private patients needing elective, i.e. non-emergency treatment will be required to avail of private or semi-private accommodation; and emergency cases will continue to be accommodated in whatever bed is available.
These measures will be of significant value to public patients and will not give rise to any reduction in the overall number of public beds. Public patients will, when the system has been implemented, face shorter waiting lists than would otherwise have been the case as the access of private non-emergency cases to these beds is gradually phased out. In addition, public patients who, because of their income, have been liable for consultants' fees although they had no wish to avail of private or semi-private care, will benefit from the removal of this liability.
In improving the position of public patients, the Government will also ensure that the public hospital system continues to cater adequately for the needs of private patients. Our public hospitals benefit greatly from having a balanced mix of public and private practice, and the Voluntary Health Insurance Board's schemes have made a major contribution to maintaining this.
The Government will be careful to ensure that the role of private medicine and of voluntary health insurance is not diminished. When the change is introduced any increased demand for private beds will not be at the expense of public beds and will be introduced on a self-funding basis only.
I would like to take this opportunity to refer to speculation in the past week that the new arrangements might lead to a substantial drop in VHI membership. There is no basis for this view. The new measures relate only to public beds, whereas virtually all of those joining VHI do so in order to have cover for private and semi-private beds. The VHI Board have confirmed to me that they have no reason to expect any significant fall in their membership, and this conclusion is also supported by independent research carried out by the ESRI.
I am satisfied that these measures will be effective in improving equity of access to public hospital services. The new arrangements will be carefully monitored to ensure that this improvement takes place as the changes are implemented.
The following is the addendum:
An objective of this programme is to ensure the greatest possible equity in the availability of health services, particularly in relation to equity of access to public hospital services. To this end, it has been agreed as part of the programme and having regard to the recommendations of the Commission on Health Funding and of the NESC, that a number of changes to the present eligibility structure are required.
The income limit for Category 2 eligibility, i.e. entitlement to a hospital services card, will be abolished from 1 June 1991, leading to two categories of eligibility instead of the present three: medical card holders will continue to be entitled to the full range of public health services as at present, and all others will be entitled to the services currently available to those at present in Category 2.
There will be some modification of the present arrangements for admission to public ward accommodation in public hospitals. Under the new system, consultants' private patients availing of public hospitals for elective, i.e. non-emergency, treatment will eventually be accommodated only in private or semi-private beds. This system will be phased in gradually during which period admission arrangements will be kept under review to ensure that they operate in an equitable manner.
The Government are committed to maintaining the position of private practice both within and outside the public hospital system. The Government also recognise the crucial role played by voluntary health insurance. In gradually implementing the new system the Government will be sensitive to the need to ensure that the public hospital system caters adequately for the requirements of private patients and that the important role and contribution of voluntary health insurance is not diminished in any way.
The assessment procedures for medical card eligibility must be sufficiently flexible to ensure that no person in genuine need of a medical card suffers hardship through failure to obtain one. There is also, however, a need for uniformity and consistency in the procedures so that persons in similar circumstances are assessed similarly in all areas. The chief executive officers of the health boards will be asked to carry out an early review of the methods of assessment used throughout the country so as to ensure that both these objectives are met.
The Minister for Health has already announced that a statutory medical card appeals system is being introduced; also that Regulations are being made to provide that a person who would otherwise be eligible for a medical card cannot lose this entitlement solely as a result of availing of the family income supplement or the social employment scheme.