Written Answers. - Psychiatric Patients Health Insurance.

Mary Harney


14 Miss Harney asked the Minister for Health his views on the impact of the regulations signed by him on 28 March 1996, allowing psychiatric patients only 100 days health insurance cover in hospitals per year; the impact, if any, this will have on the families of such patients and the community at large in view of the fact that our health insurance providers should not be permitted in law to discriminate in this manner; and if he will make a statement on the matter. [8754/96]

,Limerick East): On 28 March 1996, I signed regulations pursuant to the Health Insurance Act, 1994. These set out arrangements to be applied in respect of the registration of health benefits undertakings, the operation by undertakings of open enrolment, the provision by undertakings of lifetime cover, the making available by undertakings of a guaranteed minimum level of benefit under their contracts and the putting into effect of a risk equalisation scheme between undertakings.

The regulatory framework provides a high degree of protection to the members of the public in the context of the opening-up of our private health insurance market to competition. As regards people who suffer from a psychiatric illness, who have the desire and means to effect private health insurance, insurers are prohibited from refusing cover, terminating existing cover because of frequency of claims or ‘loading' premiums to discourage the availing of cover. It guarantees to the insured person a specified level of indemnity for a period of not less than 100 days in-patient services in a year. Prior to the regulations there were no such expressed statutory guarantees available.
The provision of a statutory guarantee of indemnity benefit for not less than 100 in-patient days represents insurance cover in excess of the three month period within which 92 per cent of discharges from private psychiatric hospitals occur. Prior to the finalisation of the regulations. I met representatives of the two major private psychiatric hospitals who indicated that a minimum cover of 100 in-patient days treatment and a commitment to include 20 day-patient days for psychiatric treatment in the regulations was acceptable to them. Furthermore, in the event of cases arising where an insurer's policy only provides for the minimum 100 days and the insured person exhausts same then he or she can avail of the entitlement to full eligibility for services under the public system, both hospital and community based.
I consider that regulations providing entitlement to a specified minimum level of indemnity cover in policies to be written by commercial insurance companies constitute a protection for the general public. I further consider that, in relation to the approach taken by insurers to limiting exposure to the provision of psychiatric benefit, the minimum level set under regulation is substantial. I do not subscribe to the view that this constitutes discrimination in circumstances where facilitating competition in the market is an issue and particularly in a system where everyone is eligible for services under the public system regardless of whether they have or had private insurance cover.