John Brassil (Kerry, Fianna Fail) | Oireachtas source

I thank the witnesses for their attendance. Without repeating questions, I will try to be as specific as I can. The terms of reference of the committee are to try to devise a health system that treats a patient in accordance with his or her need rather than his or her ability to pay. According to our objective, were we successful in what we do and were everybody treated in accordance with his or her need, I wonder how many people would take out private health insurance and use private hospitals. The fundamental issue is that people who can afford health insurance get treated and those who cannot, wait. That is the system we are in and about which we are tasked with trying to do something.

In respect of consultants who work in both the private and public systems, do the witnesses know what percentage of consultants - if not across the private system, in their hospitals - do both public and private work? How many work specifically for the private hospitals? I would be interested in that figure if they have it. I know the question was asked but I would like them to come back, if possible, with a specific figure. I am sure they would know the cost of a hip or knee operation.

May I ask the representatives from the PHA to provide the committee with a figure for the cost of a knee operation in a private hospital so that we could compare it with what it costs in the public system?

A witness during an earlier hearing told us that it was six times more expensive to get a procedure done in the public system than it was in the private system. I would like information to back up that comparison so it would be helpful if the representatives would provide us with those figures.

What percentage of the income of private hospitals comes from the public purse as opposed to the income from health insurance? It might have been said that the private hospitals are at full capacity in terms of beds. What percentage of beds in the health service are in the private hospitals sector? In terms of diagnostics, what is the percentage capacity to provide MRI and CAT scans? It would be very useful to know the available capacity in the private hospital system.

We have been made aware that many people in the age 70 plus category who have private medical insurance now have a medical card, as the income guidelines for medical cards are far more generous. One could have a situation where a patient with insurance goes into the private hospital for medical conditions or even an elective hip operation but following discharge would need community health care. Is there a good liaison system, whereby the private hospitals work with the home care teams, the people who set up home help hours, the community welfare nurses and so on or are they simply referred to the GP?

We were told that about 30% of the 70 hospitals are private hospitals, that the private hospitals employ 8,000 staff, have 2,500 beds, conducting 250,000 procedures and carrying out 3 million diagnostic tests. Would the witnesses be able to provide an overall cost for the service, so that we would be able to compare the cost of that service in the private sector with the public system? That would be beneficial.

I have a specific question for Mr. Brian Fitzgerald because he has 25 years experience in management in both the public and private system. I am asking for an honest assessment of the percentage efficiency in the private hospitals versus the efficiency of the public system? Can he tell us what the private hospitals do better, I suspect the private hospitals would run at higher efficiency and I wonder what Mr. Fitzgerald does better now than previously when he was in the public system. What is the reason for the great efficiency?