Jan O'Sullivan (Limerick East, Labour)
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Question 192: To ask the Minister for Health and Children if a voluntary hospital, meaning a hospital which is substantially funded by means of an arrangement with the Health Service Executive under section 38 of the Health Act 2004, can also be a private hospital for the purposes of the Health Insurance Act 1994 (Minimum Benefit) Regulations 1996, meaning a hospital which provides prescribed health services but does not provide services to persons pursuant to their entitlements under Chapter II of Part IV of the Health Act 1970; if not, the reason for same; and if she will make a statement on the matter. [16391/08]

Jan O'Sullivan (Limerick East, Labour)
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Question 194: To ask the Minister for Health and Children the services provided to persons pursuant to their entitlements under Chapter II of Part IV of the Health Act 1970, as referred to in the Health Insurance Act 1994 (Minimum Benefit) Regulations 1996; and if she will make a statement on the matter. [16393/08]

Mary Harney (Dublin Mid West, Progressive Democrats)
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I propose to take Questions Nos. 192 and 194 together.

Chapter II of Part IV of the Health Act 1970 requires the Health Service Executive to provide inpatient and outpatient services to persons with full eligibility and persons with limited eligibility, and allows for them to provide ambulance services. Inpatient and outpatient services within the meaning of the Health Act, 1970 are publicly funded services, provided by or on behalf of the Health Service Executive. Under Chapter II patients attending hospitals providing these services, including voluntary hospitals, may avail of inpatient services as either public or private patients, hence the reference in the Health Insurance Act (Minimum Benefit) Regulations, 1996. The Health Insurance Act (Minimum Benefit) Regulations 1996 serve a different purpose, insofar as they prescribe the minimum level of cover to be provided under health insurance contracts, and as such they are not comparable. Under these Regulations a private hospital means a hospital, other than a nursing home, which is not a publicly funded hospital.

Jan O'Sullivan (Limerick East, Labour)
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Question 193: To ask the Minister for Health and Children the class of persons who have an entitlement to receive services from voluntary hospitals not provided or maintained by the Health Service Executive but substantially funded by it; the class of persons who have an entitlement to receive in-patient services from hospitals provided and maintained by the HSE itself; if any distinction is made for the purpose; if the arrangement between the HSE and the hospitals in question provides for an entitlement on the part of those with full eligibility under the Health Act 1970 to avail of services in those hospitals; and if she will make a statement on the matter. [16392/08]

Mary Harney (Dublin Mid West, Progressive Democrats)
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Eligibility for health services, including hospital services, is based on residency. Any person accepted by the Health Service Executive as being ordinarily resident in Ireland is entitled to either full eligibility or limited eligibility. Where a voluntary hospital enters into an agreement with the Health Service Executive under Section 38 of the Health Act 2004, all persons are eligible to avail of publicly funded hospital services which are being provided by the voluntary hospital on behalf of the HSE. From an eligibility perspective, there is no distinction made between publicly funded services provided by the HSE directly or those provided on its behalf.

Jan O'Sullivan (Limerick East, Labour)
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Question 195: To ask the Minister for Health and Children if she is satisfied that the Health Service Executive has a full statutory basis for the services it provides free of charge, the services it provides at a fee and the services it provides on an optional or occasional basis; her views on the demographic and geographic anomalies that arise in the provision of services by the HSE throughout the State; and if she will make a statement on the matter. [16395/08]

Mary Harney (Dublin Mid West, Progressive Democrats)
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The Health Service Executive (HSE) has a range of functions under the Health Acts 1947 to 2007 and other Acts including the Child Care Acts 1991 to 2007 and the Mental Health Acts 1945 to 2001.

The Health Act 1970 provides broadly for persons to have either full or limited eligibility for health services. Persons with full eligibility are entitled to general practitioner services, prescribed drugs, medicines and appliances, all in-patient public hospital services in public wards including consultant services, all out-patient public hospital services including consultant services, dental, ophthalmic and aural services and appliances, child health services, home nursing and a maternity and infant care service.

Persons with limited eligibility are eligible for in-patient public hospital services in public wards including consultant services, outpatient public hospital services including consultant services. Dental and routine ophthalmic and aural services are not provided by the State, but this treatment is provided to children who have been referred from a child health clinic or a school health examination. A maternity and infant care service is provided during pregnancy and up to six weeks after birth. In 2005, the GP Visit Card was introduced as a graduated benefit, so that people on lower incomes, particularly parents of young children, who do not qualify for a medical card would not be deterred on cost grounds from visiting their GP.

Provision is made for charges in a number of areas, including inpatient charges and certain outpatient charges. There is also provision that persons with limited eligibility must meet the first €90 of prescribed drugs costs per month, above which the Drug Payments Scheme meets all further costs.

Before the establishment of the HSE, some variation in practice had developed over time, between the individual health boards, in relation to the provision of certain services. In the HSE's National Service Plan 2008, Section 8 of the Plan describes Consistency and Social Inclusion initiatives which are designed to provide and improve consistency of service provisions, ensure geographical equity and equity of access to treatment and care.

Jan O'Sullivan (Limerick East, Labour)
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Question 196: To ask the Minister for Health and Children if she has arrived at a conclusion on the question as to whether persons specified as having full eligibility for services under the Health Act 1970 have a statutory entitlement to those services; if officials of her Department are still reviewing the question; when they might be expected to report; and if she will make a statement on the matter. [16396/08]

Mary Harney (Dublin Mid West, Progressive Democrats)
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The Health Act, 1970 (as amended) provides for two categories of eligibility for all persons ordinarily resident in the country, i.e. full eligibility (medical card) and limited eligibility (all others). Entitlement to a medical card is determined mainly by reference to means, with provision for discretion to grant a card in cases of 'undue hardship' where the income guidelines are exceeded. All persons aged over 70 years have full eligibility regardless of means.

Medical card holders are entitled to a full range of services including general practitioner services, prescribed drugs and medicines, all in-patient public hospital services in public wards including consultants services, all out-patient public hospital services including consultants services, dental, ophthalmic and aural services and appliances and a maternity and infant care service. Determination of eligibility for medical cards is the responsibility of the Health Service Executive.

As the Deputy will be aware, the current legislation has been in place for many years and there is a need now to have a clear set of statutory provisions that ensure equity and transparency and to bring the system up to date with developments in service delivery and technology that have occurred since the Health Act 1970. Accordingly, work is under way in the Department on a new legislative framework to provide for clear statutory provisions on eligibility and entitlement for health and personal social services. The legislation will define specific health and personal social services more clearly; set out who should be eligible for what services, as well as criteria for eligibility; establish when and in what circumstances charges may be made and provide for an appeals framework. As the Deputy will appreciate, this is a very complex undertaking as the current legislation has been in place since 1970, and there have been significant developments in services since then, with a growing emphasis on delivery of care in a community rather than institutional setting. Given the complexities around this area, it will be necessary to obtain comprehensive legal advice in relation to the proposed legislation.