Dáil Éireann díospóireacht -
Thursday, 28 Jun 2001

Vol. 539 No. 3

Written Answers. - Hospital Accommodation.

Jan O'Sullivan

Ceist:

60 Ms O'Sullivan asked the Minister for Health and Children if he is considering a proposal for the Department of Finance to exclude private patients from public hospitals; and if he will make a statement on the matter. [19215/01]

Minister for Health and Children (Mr. Martin):

There is currently no proposal from the Department of Finance to exclude private patients from public hospitals. The Finance Act, 2001, includes measures which allow for the establishment of private hospital facilities under certain conditions which include provisions to ensure that 20% of the capacity of such facilities would be made available annually for the treatment of persons who have been awaiting in-patient or out-patient services as public patients subject to service requirements specified by the health board in whose area the facility is located.

The private hospital concerned must provide a discount of at least 10% to the State in respect of fees to be charged in regard to the treatment of any such public patients as compared to the fees charged in respect of similar treatment afforded to a person who has private health insurance. The intention of these measures is also that the benefits in terms of additional beds should be captured for the public system by the redesignation as public of an equivalent number of beds in the public system that had been designated as private. The aim of this is to reduce pressure on public hospital beds.

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.

The 1991 Act also provides that beds in public hospitals are formally designated as public, private or non-designated. The Health Service (In-Patient) Regulations, 1991, which were introduced pursuant to the Health (Amendment) Act, 1991, state that a hospital providing services under section 52 and 55 of the Health Act, 1970, shall designate every bed, other than non-designated beds as a designated public bed or a designated private bed. The category non-designated beds refers to beds such as intensive care beds which it was not considered appropriate to designate as public or private. In its report published late last year, Private Practice in Irish Public Hospitals, the ESRI found that about 20% of in-patient beds in acute public hospitals are currently designated as being for private patient use.

The report shows that, of the total number of public bed days used, approximately 6% were used by private patients and that about 23% of all in-patient bed-days spent by private patients in public hospitals were in beds designated as public. In addition, the report also shows that there is a crossover of slightly lower absolute volume in the other direction, that is of public patients into private beds. The authors suggest that improvements to the reporting and monitoring of the arrangements could be piloted in hospitals where "crossover" is most prevalent. The report states that the main factor identified by hospital management as leading to private patients being accommodated in public beds was admission through accident and emergency departments. This largely reflects the need to accommodate patients in the most appropriate available bed irrespective of its designation. The public private mix in public hospitals is under continual assessment by my Department to ensure that the best possible service is available to all patients but particularly the public patient. This assessment includes monitoring of the bed designation system whereby the approval of the Minister for Health and Children must be obtained by public agencies for any increase in the designation.

The Deputy may also be aware that I have initiated a study of bed capacity in response to commitments in the Programme for Prosperity and Fairness. This study is examining both acute and non-acute bed numbers and will deal with issues relating to bed numbers throughout the public system.

As the Deputy is no doubt aware, I am currently preparing a new national health strategy for submission to the Government. The new strategy will be informed by a number of recent studies such as the bed capacity review and the value for money audit.