I propose to take Questions Nos. 191 and 201 together.
It is Government policy to move towards charging the full economic cost for the provision of private acute in-patient services. Persons who opt to be treated on a private basis on admission to hospital are liable for the fees of all consultants involved in his or her care and for hospital charges under Section 55 for that episode of care. Those charges are a per diem rate set out in the 2013 legislation and were informed by overall cost of the provision of the private in-patient services and the policy of moving towards the recovery of full economic cost, but they are not directly related to the cost of specific treatments provided to individual private patients, the level of complexity of a case or the costs of individual hospitals.
The issue of hospital financing has been the subject of recent Departmental reports. In the case of public acute hospital care, a prospective, casemix-adjusted activity based system was recommended. It has been recommended that the existing ‘per diem’ charging regime for private activity in public hospitals be replaced by a case-based charge using DRGs. Taking account of international evidence and of the detailed analysis already undertaken in the context of the above reports it was advised that the Programme for Government commitment on ‘Money Follows the Patient’ should be realised through the introduction of a prospective Diagnosis-Related Group (DRG) case-based payment system. Since January, 2014 the Diagnosis Related Group (DRG) grouping system has been used to facilitate the introduction of a new prospective, case-based funding model for public hospital care called Activity Based Funding (ABF - also known as Money Follows the Patient).
Activity Based Funding is being rolled-out on a phased basis and full implementation will take a number of years. The ABF approach is initially being applied to in-patient and daycase activity in public hospitals. It is the Government’s intention to develop policy proposals for the introduction of a case-based charging system for private patients in public hospitals. However, it must be acknowledged that given the complexity and breadth of the issues to be examined and addressed, significant preparatory policy work must be undertaken. This work must take full account of eligibility and legal issues, private income issues and the need for a sustainable mechanism for meeting the cost of private patients in public hospitals. It would require substantial technical work and analysis on the financial impact on public hospitals. The focus for the short to medium term is on implementing ABF in the public system, as outlined in the recently launched HSE ABF Implementation Plan 2015 – 2017. Until this further work has been completed it will not be possible to present the Deputy with the figure requested.