7 Mr. McGinley asked the Minister for Health if he will outline his views on the recommendation of the Commission on Health Funding that charges for in-patient care are inappropriate; and if he will make a statement on the matter.
22 Mr. McGinley asked the Minister for Health if he will outline his views on the recommendation of the Commission on Health Funding that charges for in-patient care are inappropriate; and if he will make a statement on the matter.
I propose to take Questions Nos. 7 and 22 together. The Commission on Health Funding did not refer to charges for in-patient care as inappropriate. On the contrary, the commission endorsed the modest charges which apply to in-patient services as a contribution towards the cost of providing them, with exclusions for appropriate groups such as medical card holders; and endorsed maintenance charges for private accommodation which reflect the full cost of providing this.
I want to refer the Minister to the health commission's report in which they state that regulatory charges are unnecessary in the case of in-patient treatment and the proposed uniform admission policy will ensure that only those in genuine need of care are admitted. It is clear from the tenure of their recommendations, as elaborated further on in the document, that they do not regard in-patient services as ones which should be charged to people on middle and low incomes who avail of these services and have to pay £12.50. Would the Minister not agree that since the commission made their recommendation he has increased this charge by 25 per cent and that this flies in the face of the commission's recommendation?
I would refer the Deputy to paragraph 12.48 of the commission's report in which they refer to the £10 charge and the £100 charge over any 12 month period for in-patient services. The commission believe that a charge of this nature does not expose patients to severe financial hardship. Medical card holders and those receiving treatment for certain conditions are exempt from this charge. The charge can be applied with discretion in circumstances where hardship might arise. They say that a charge of this magnitude can be justified on the basis that it goes some way towards reducing the cost to taxpayers of services provided to the individual patient, particularly in relation to hotel costs such as food and bed linen as distinct from medical or nursing care.
I too believe that the charges are modest. It is appropriate that where patients use a hospital bed it should not cost them less than it would cost them to have treatment through their general practitioner and the provision of drugs outside the hospital. I am sure Deputies will agree that financial incentives should not be put in the way of patients to go to hospital.
May I——
I want to call your colleague, Deputy Allen, who offered earlier.
May I ask the Minister when he proposes to introduce the regulation which will eliminate the charge imposed on medical card holders who spend more than 30 days in hospital in any one year? When will the Minister eliminate this unjustice?
That is a rather specific matter worthy of a separate question.
Surely it is worthy of an answer.
It is unfair of the Minister to compare hotels with hospitals. Nobody wants to go to hospital.
Those were not my words. I was quoting from the report of the Commission on Health Funding.
It should be pointed out to the authors of that report that it is not a fair comparison. Is the Minister aware of the number of appeals all of us have to make to health boards in relation to this charge? Many of the people in the category referred to by the Minister have asked us to appeal to the health boards on their behalf because of their inability to pay this charge.
When these charges were introduced a number of categories were exempted. For example, 35 per cent of the population have medical cards and they are all exempt from these charges.
Not all of them.
Under the mother and child scheme, women and infants are also exempt from these charges. Children with certain diseases are also exempt from these charges. In addition the chief executive officer of the health board has discretion to ensure that no one who is unable to pay will have to pay this charge. It is to the credit of the Irish health services that no person has ever been denied treatment because of inability to pay.
Medical card holders are no longer exempt.
The Minister said that 35 per cent of the population have medical cards. This figure has been reduced to 33 per cent nationally and lower in some health board areas. Would the Minister not agree that this charge is a burden on those people who are marginally over the limit for full eligibility? Would he also agree that the charge for respite care, which is now being imposed by health boards, is not being done according to the regulations?
As I said, the chief executive officers of health boards can use their discretion in such cases. As the Deputies are aware, that discretion is being used by chief executive officers——
By how many of them?
By all of them. With regard to the question of charges which was referred to by Deputies Sherlock and Allen, these are governed by the institutional regulations going back to 1976——
What about the position of patients in acute hospitals?
If the Deputies have evidence which shows that medical card holders and patients in receipt of acute medical treatment are being asked to pay a charge if they are in hospital for longer than 30 days, I should like them to give it to me. Under those regulations, which were brought in by the Fine Gael-Labour Coalition Government in 1976, patients in long-stay care are obliged to pay a charge——
They are not obliged to pay for acute care.
The Minister is bluffing. As the Minister knows, patients in receipt of acute care are being charged. For example, patients in St. Stephens Hospital——
I want to see evidence of that. I made inquiries but I could not get evidence. If Deputy Allen has evidence that acute patients are being charged——
I will give it to the Minister.
The Deputy should cease interrupting the Minister.
He is trying to help him.
Acute psychiatric hospitals are included——
It is acute care——
I asked the Deputy to desist from interrupting and he may not ignore me in that regard.
The regulations to which I have referred apply to long-stay hospitals, psychiatric hospitals and homes and hospitals for the elderly. A patient who spends longer than 30 days in any one of these hospitals is required to pay a charge. My information is that patients receiving ongoing acute medical treatment in acute general hospitals are not obliged to pay a charge. However, in cases where patients are being maintained in acute hospitals for whatever reason the charge is made after 30 days.
I want to put the record straight. For the second time the Minister has accused the late Brendan Corish of bringing in a regulation in 1976 imposing charges on people in acute care, but that is not correct. No patient with a medical card was ever charged for acute treatment.
In fairness to Deputy Ferris and, indeed, to the late Deputy Corish when he was Minister for Health, I did not say that. I said that I have no information on the matter. In my view patients in acute hospitals for acute medical treatment should not be charged under those regulations, and that has been the position. For example, in one acute hospital a patient has been in residence for four years.
That is the Minister's problem. That should not happen.
In those circumstances it is appropriate that the charge apply in the same way as if that patient was in a long stay institution.
The Minister is bringing in red herrings to avoid the central issue. Will the Minister stand over the situation in St. Stephen's Hospital, Sarsfield Court, Cork, an acute psychiatric hospital?
It is not an acute general hospital.
It is an acute psychiatric hospital. I am surprised at the Minister differentiating between a psychiatric and a general hospital.
Deputy Allen is raising a specific matter appertaining to a particular hospital.
I was challenged.
That is beside the point. That matter should be raised by way of a special question.
Will the Minister stand over a position whereby medical card holders are being charged in-patient charges after 30 days in any one year in an acute psychiatric hospital?
The regulations introduced in 1976, as I have already said, apply to long stay hospitals for the elderly and psychiatric hospitals, and that always has been the case.
I specifically said acute psychiatric hospitals.
Please, Deputy Allen. I am calling Deputy Richard Bruton.
I would like to revert to the question of in-patient hospital charges and the hardship they cause. Would the Minister not accept that a married couple on £112 per week who do not qualify for a medical card should not have to pay £125 for in-patient care? Would he not therefore provide some system of exempting such persons on low incomes from charges of that magnitude?
This is one of the areas where the chief executive officers have discretion in the matter and I am satisfied that they will use that discretion appropriately. I take the point that people earning £112 a week, £1 above the medical card limit, would not be in a position to pay, but I also accept that the chief executive officer or his agent would take that into consideration.
He would not waive the charges unless the person is cute enough to apply.
Order, No. 8.
