Written Answers. - Health Insurance Regulations.

Ivor Callely


65 Mr. Callely asked the Minister for Health the issues of concern that have been brought to his attention to date regarding the Health Insurance Act, 1994, Regulations; the submissions he has received in this regard; his response to the issues raised; and if he will make a statement on the matter. [8820/96]

,Limerick East): The Health Insurance Regulations were signed by me and laid before the House of the Oireachtas on 28 March 1996.

One group which represents the views of persons suffering from certain psychiatric conditions has expressed concern about the minimum annual period of psychiatric in-patient cover which insurers will be legally obliged to provide under their policies. The regulations provide that the minimum period of guaranteed cover in respect of private psychiatric in-patient care is to be 100 days in a year. Furthermore, I am committed to making provision, at an early date, for a further period of 20 days day-patient care in private psychiatric hospitals. This is a significant improvement on the 40 days in-patient cover which was the original proposal on psychiatric cover. The level of cover now provided as a statutory minimum compares very favourably with the position taken by insurers elsewhere who specifically limit, in some cases extensively, their exposure to risk in the area of psychiatric illness or do not cover it at all. It is the practice of foreign insurers to exercise pre-authorisation of admissions to psychiatric hospitals and to otherwise be in a position to significantly qualify the basis on which benefit may be payable. My Department is not aware of any other case internationally where providers of private health insurance contract to make available cover for a period of 100 days psychiatric in-patient services without pre-certification and in an environment where the entire population is eligible for a free public psychiatric service.

The 1994 report of the Health Research Board shows that 92 per cent of discharges from private psychiatric hospitals occurred within three months. Where circumstances arise that an insured person requires treatment in excess of 100 days, later to be increased to 120 days, in a year and where the policy does not cater for this, it will be open to him or her to avail of treatment in public psychiatric hospitals and public community-based facilities.
Prior to finalising the regulations I met with representatives of the two major private psychiatric hospitals to whom the proposals on minimum benefit in respect of psychiatric in-patient and day-patient services were acceptable in the context of an open competitive health insurance market.
There was concern raised regarding the extent of out-patient cover provided under the regulations. I believe that the provision made is appropriate to the core hospital and consultant related services which are the subject matter of the regulations. Furthermore, it would be inappropriate and an unsustainable imposition on freedom to provide services under the EU's Third Non-Life Directive to seek to prescribe, as a minimum entitlement, a comprehensive out-patient service that would exceed what is generally available in the market at present. It is already apparent that insurers will compete more on products than on premium costs, in the first instance, so the regulations must avoid unduly curtailing their latitude for product design. Concern previously raised about the absence of provision of ancillary health services such as ambulance services in minimum benefit regulations was not sustainable under regulations which have as their core objective the protection of community rating within a competitive environment. There was concern from the insurance sector about some indemnity aspects of the regulations but my Department was satisfied that the provisions were appropriate.
The only submission following the signing of the regulations, of which my Department is aware, relates to the issue of minimum guaranteed cover in respect of psychiatric services.