Dáil Éireann díospóireacht -
Thursday, 10 May 2001

Vol. 536 No. 1

Written Answers - Private Health Care.

Noel Ahern

Ceist:

110 Mr. N. Ahern asked the Minister for Health and Children the situation regarding persons who provide for themselves in private nursing homes or hospitals; the reason they are not given credit for the public cost of such care; the basis for this arrangement; if this rule has been tested constitutionally; and if this ruling has ever been tested against European law or before European bodies. [13411/01]

Minister for Health and Children (Mr. Martin)

Entitlement to health services is primarily based on means and there are two categories of eligibility. Persons in category 1 are medical card holders and they are entitled to a full range of public health services free of charge. Persons in category 2, non-medical card holders, have limited eligibility for health services, including an entitlement to public hospital and public consultant treatment subject only to modest statutory charges. Charges for care for nursing homes or hospitals may be made under a number of regulations set out below. The constitutionality of these regulations has not been tested. Charges for long stay care can be made under two sets of regulations. They can be made under the Institutional Assistance Regulations, 1965, where the patient receives "shelter and maintenance" rather than treatment. These apply from the date of admission and are payable by all patients who are in receipt of incomes including medical card holders and persons with dependants.

Charges can also be made under the Health (Charges for In-Patient Services) Regulations, 1976, as amended by the Health (Charges for In-Patient Services) (Amendment) Regulations, 1987. These regulations enable charges to be made towards the cost of providing hospital in-patient services for persons with income who have been in receipt of such services for more than 30 days or for periods totalling more than 30 days within the previous 12 months. Medical card holders and persons with dependants are exempt from these charges. In practice, however, persons in health board long-stay care do not usually hold medical cards as the board meets the cost of all of the person's health needs and, thus, the person ceases to qualify for a medical card in accordance with the criteria laid down in section 45 of the Health Act, 1970.

Public hospital statutory charges are based on the principle that those who can afford to do so should make a contribution towards the cost of providing hospital services. There are a number of exemptions to the charge, including medical card holders. Where the exemptions do not apply the charge may be waived if, in the opinion of the chief executive officer of the appropriate health board, payment would cause undue hardship. In deciding the amount to be contributed, health boards have regard to the person's individual circumstances. Allowance is made for any financial commitments the person may have and a reasonable amount is left to meet the person's personal needs.

Under arrangements for public hospital services introduced in June 1991, on foot of the Health (Amendment) Act, 1991, everyone, regardless of income is entitled to public hospital and public consultant services subject only to modest statutory charges, from which medical card holders are exempt. Alternatively one can opt to be the private patient of both the consultant and the hospital. Private patients are liable for the appropriate accommodation charges and consultants fees in addition to the statutory charges. Where one opts to be treated privately, the matter of consultant fees is a private arrangement between the patient and the consultant and I have no function in this matter.

Under the Health (Nursing Homes) Act, 1990, health boards provide subventions to assist persons in meeting the costs of nursing home care. However, it was never intended that subventions would meet the full costs involved. The placement of a person in a private nursing home and the fees charged is a private arrangement between the nursing home and the individual resident. I have no function in relation to the setting of private nursing home fees. Nonetheless, the State recognises the contributions paid towards the cost of private nursing home care by allowing these charges to be offset against tax liabilities. The requirement that patients make an explicit choice between public and private care was recommended by the commission on health funding on the grounds of equity since, under the previous system, it was possible that some public patients of the hospital could receive preferential treatment over other public patients by virtue of either being private to the consultant or by obtaining a private bed. All persons, including medical card holders, who opt for private treatment are liable for any expenses they incur.