Michael Noonan
Ceist:10 Mr. Noonan (Limerick East) asked the Minister for Health whether the issue of balance billing has caused a diminution of services available to patients or hospitals; and if he will make a statement on the matter.
Ceisteanna — Questions. Oral Answers. - Balance Billing by Consultants.
I am not aware that the practice of balance billing on the part of some consultants has had any such impact. However, I am supportive of the continuing efforts by the VHI to maximise the number of consultants who are fully participating and thus to reduce the incidence of balance billing.
Will the Minister indicate to the House whether he will use his influence, which is no doubt considerable, with both the consultants and the VHI to ensure that this practice is eliminated and with the objective of making available to patients all possible information at a time when they are under considerable stress? Also, in view of some of the developments reported recently, will the Minister take a more personal interest in the problem with a view to using that influence effectively?
I do not wish to overstate my influence with the consultants or with the VHI——
(Carlow-Kilkenny): The Minister is too modest.
——but I am strongly supportive of the efforts of the VHI to ensure that every consultant is a fully participating consultant and that no further bills are sent to patients after treatment. Obviously, there is a contractual arrangement between the VHI and the individual consultants and I hope all consultants will be signed up to a fully inclusive service so that the subscriber to the VHI will know that all the costs will be covered and he or she will not be receiving any surprise bills.
The question of information is a separate issue. During the time of the disagreement between the VHI board and the Irish Hospital Consultants Association in relation to information, it was my strong view that every subscriber to the VHI was entitled to know the extent of the cover. If it is not possible to have every consultant participating fully, the subscriber is entitled to know which consultants are fully participating and which are not.
Will the Minister agree that he has a certain responsibility to ensure that that information is accessible to the public? One way of doing that would be to extend the patients' charter, which was introduced by the Minister's predecessor, to include the VHI subscriber. If the VHI is not publishing this information, does the Minister not feel he has a responsibility to do so in the interest of the patients? Not only would that be of benefit to the patients but it might encourage more consultants to participate in the scheme. Surely the Minister has a responsibility in this regard.
I do not have a responsibility to publish data I do not possess but I am glad the VHI is making that information available by telephone and through the list of participating consultants which has been circulated to general practitioners. The information, therefore, is available to every subscriber on the telephone lines made available by the VHI so there should be no lack of information in this regard. The real objective I hope to achieve is to ensure there is full participation by all consultants. There will be a further complication, however, in July when there will be an opening of competition under the third EU directive. I must introduce legislation here to set the framework for that. I do not want competition to be health inflationary, however, because the subscriber to the VHI will have to pay. I am determined to ensure there is open information and that the criteria we lay down — community rating, lifelong cover, open enrolment etc. — are preserved.
I am glad to hear the Minister taking such an interest in the VHI. I remember a time when he was reluctant to become involved in the issues of private health care and private health insurance, saying he was the Minister for public health. Is the Minister aware that the VHI has refused to cover the cost that may be incurred by a woman seeking to have tests carried out privately for hepatitis C? Will the Minister comment on that in relation to the patients' charter to which he referred and in relation to the VHI's responsibilities to its patients?
I am primarily the Minister for public health——
That is correct.
——and I have a responsibility to ensure that the public health service is of the best quality. I have other responsibilities also. The VHI is vested in me; I am the 100 per cent shareholder of the VHI on behalf of the people of Ireland and I have responsibilities, under the EU directive, to prepare the framework for open health insurance. I take those responsibilities seriously. Much work has been done in relation to preparing the ground work for the regulation of health insurance here. Clearly the scale of private health insurance will impact on the quality and scale of public health provisions and both of those will then become my responsibility to some extent.
On the specific question regarding the VHI covering tests for hepatitis C, I do not want to get into that area because there is a private contractual obligation between an insurer and an individual client. The rules are determined by the insurer, in this case the VHI, and the schedule of services it provides. I understand, however, that they do not normally cover infectious diseases as described under the Infectious Diseases Act and in this case it has refused to provide cover. Now that my attention has been brought to this matter I will investigate it but I am not sure what role, if any, I have in addressing what is a contractual arrangement between a subscriber and an insurance company.
In regard to the changes that will be introduced because of the EU directive, will subscribers be provided with the full information, which they are not getting at present, with regard to participating and non-participating consultants? Will there be a guaranteed right to patients of direct access to information as opposed to its being filtered through a GP or by telephone?
I do not want to give the chapter and verse contents of legislation that I will, in due course, bring before the House. I have given the flavour of it in that it will set the parameters and ground rules for any private insurance company wishing to operate in the jurisdiction subsequent to the opening of the internal market on private health insurance from 1 July. I am of the view that that information is an entitlement as of now——
The Minister should provide it.
——and that we should not have to wait for any further legislation. There is no filtering of information by using the telephone. Many of us obtain first hand quality information on the telephone. Every VHI subscriber is entitled to know whether any consultant is fully participating. All the subscriber has to do to obtain that information is pick up a telephone.
It is too late.