Oireachtas Joint and Select Committees

Wednesday, 18 January 2017

Select Committee on the Future of Healthcare

Health Service Reform: Private Hospitals Association

9:00 am

Mr. Brian Fitzgerald:

A question came up about the term "cherry picking". I have explained about some of the cohorts of patients, so I do not want to go over that ground. We take patients with strokes and patients who are having cardiac events. We have an ICU with 14 beds and eight staff because that is the relevant demand that exists. We have 24-7 anaesthetic cover and medical cover. Therefore, in terms of the experience I have in both settings, it is the same for that cohort of patients, notwithstanding the other patients who are referred elsewhere.

On diagnostics, the point I was making earlier is that we have no incentive to over-test. We do not get paid for each individual test, unlike the fee-for-service approach one would find in North America. We get paid a package price regardless, so if we do ten MRIs, we get the same rate. As happens in the public system also, there is mixture of trained doctors. We have many doctors who have been trained abroad in different systems, for example, in North America or the Middle East. They are trained in different medicine and they tend to test more if they are trained in those systems. That is probably because those systems are incentivised, but that is how they are trained. In Ireland we are not paid for those tests, so there is no incentive.

The point on medical equipment is interesting. We have just gone through an expansion programme, which we funded in three ways. First, if we generate enough funds, we buy the equipment outright because we find that to be the most efficient way of procuring. Second, we have also used bank debt. The third area, which is becoming more prominent, is what are called managed equipment service contracts, where there is a mixture of servicing and capital cost over a prolonged period. The servicing of our equipment is managed by an in-house medical physics team similar to what one would find in the public system. In fact, the team members in the Beacon were trained in the public system and they would collaborate quite a lot with their colleagues in the public system.

The shortage of consultants came up in several questions. Without getting into drop-dead remuneration, the packages that are designed are salaries, and the salary would typically be about 50% more than the starting public salary. The starting salary for a type B consultant is €120,000 and it drops to €106,000 for a type C consultant, so one could add on about 50% to that. In addition, consultants coming back to Ireland are facing extreme medical indemnity costs. A typical surgeon in a very complex specialty is probably paying €70,000 a year in medical indemnity, and I have seen rates of up to €100,000 a year. For consultants coming back to Ireland to set up practice, bearing in mind they are making professional fees, it takes a while to establish a practice, so they need support for the first couple of years.