Although patients may be treated in public hospitals on a private basis, the core purpose of the public hospital system is to provide services for all patients under the statutory eligibility provisions. All persons ordinarily resident in Ireland have full eligibility for hospital services, meaning that there is universal access to public hospital care. The fact that a person may have private health insurance does not take away from his/her eligibility for services as a public patient. Care is needed to ensure that a perceived need to generate income does not operate to the detriment of service provision to public patients. The primary objective must be to avoid an excessive ratio of private practice within public hospitals and, subject to that being achieved, to recover whatever income is due in respect of that level of private practice.
The Government's focus is to achieve fair access by patients to publicly-funded hospital capacity based on medical need. The new consultants' contract includes new rules on consultants' public-private mix of patients and new measures to manage these rules by newly-appointed clinical directors. These contractual features complement existing bed designation rules.
Bed designation was introduced as part of the overall framework to control the level of private activity in publicly funded hospitals. Under the Health (In-Patient) Regulations 1991, beds in public hospitals are categorised as public, private or non-designated. Under these regulations, no private patient being admitted electively may be accommodated in a designated public bed. The regulations contain reciprocal provisions regarding the accommodation of public patients in beds designated as private. There is provision for some exceptions to cater for emergencies. An approximate 80:20 public/private ratio applies.
The national average number of acute hospital beds available in public hospitals in 2007, the latest year for which validated data has been compiled by the HSE, is 13,688. Of these over 10,200 were categorised as public, over 2,400 were categorised as private and the remainder as non-designated.
The HSE Performance Reports indicate that the percentage mix of activity in acute hospitals in 2007 was 75.1% public to 24.9% private and in 2008 was 74.1% public to 25.9% private. The corresponding figure up to September 2009, the latest month for which data is currently available, stood at 75.2% public to 24.8% private. While this data indicates some slight improvement in the public /private activity mix it shows the importance of ensuring that the range of measures to control private activity that are now in place are fully implemented.
