Simon Harris (Wicklow, Fine Gael) | Oireachtas source

I thank Deputy Kelleher for this question. I acknowledge the Deputy has raised the issue with me previously in the Oireachtas Committee on Health and when we were considering the Health Insurance (Amendment) Act. I acknowledge his interest in the issue and wish to put a little information on the record of the House on the policy rationale behind this when it was originally put in place.

As the Deputy knows, although a proportion of activity in public hospitals involves the provision of care to private patients, the core purpose of our public health system is obviously to provide services for public patients. Government policy is to ensure that there is equitable access for public patients, that the proportion of private activity is appropriately controlled and that the costs of provision of services to private patients are recouped by public hospitals. It is important to note that when patients are admitted to hospital, they can choose whether to be treated as private or public patients.

The Health (Amendment) Act 2013 provided for the charging of all private inpatients. The Act addressed a situation identified by the Comptroller and Auditor General in his 2008 report whereby when a private inpatient was accommodated in a public or non-designated bed, no private inpatient charge applied. The report of the Comptroller and Auditor General noted that in 2008, 45% of all private inpatient throughput was not the subject of a maintenance charge because the patient was accommodated in a designated public bed. A further 5% was not charged for because the patient was accommodated in a non-designated bed, with the result that only 50% of private inpatient throughput gave rise to any maintenance charge at all. This was despite the fact that due to treatment costs, the type of room in which a patient is accommodated is by no means the major contributor to the overall costs of a hospital stay.

The absence of a maintenance charge in such instances represented a significant loss of income to the public hospital system and to taxpayers - I think this was generally accepted by many parties at the time - and was an indirect subsidy to private insurance companies, which cover most private patients. The additional income generated as a result of the enactment of the 2013 legislation is a key element of the funding to the public hospital system and any curtailment of this funding stream would put pressure on the taxpayer to maintain services.

I intend to review this, as the Deputy knows, and I will outline in my next response what I intend to do in this regard.

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