Hospitals charging VHI nine times more than GPs for simple procedures
HOSPITALS are charging health insurance companies up to nine times more than GPs for carrying out the same routine procedures.
The huge price gap is being cited by Health Minister James Reilly as a significant contributory factor in rising premiums, particularly for VHI customers.
Many customers of the insurance company choose to get relatively simple procedures, such as removal of moles or joint injections for arthritis, done in hospitals -- even though many GPs provide the same service at a fraction of the cost.
The huge difference in price is mostly due to large fees charged by public hospitals to use their day-room facilities for these so-called 'side-room' procedures.
In many cases this adds over €700 to bills covered by health- insurance firms.
The state-owned VHI, in particular, has been accused of failing to save tens of millions of euro in payouts each year by not insisting more patients avoid hospitals and get treatments at their local GP.
Dr Reilly, who condemned the recent 9pc VHI premium hike, said he would examine these price differences.
Figures obtained by the Irish Independent show how one VHI customer can cost the company up to nine times more than another, even though they are getting the same treatment.
For example, one procedure, the removal of a mole or skin lesion, can cost between €43 and €106 if done in a GP's surgery.
Consultant
The same procedure would cost between €99 and €135 in a private hospital when the consultant's fee and cost of a side-room are combined.
And it would cost up to €836 in some public hospitals. This is because a room fee is charged in most cases, ranging from €586 to €753.
Another routine treatment, where sufferers of haemochromatosis -- a condition where someone has too much iron in their system -- need to have blood removed, can cost the insurance company just €92 if carried out in a GP's surgery.
But the cost billed to the insurer increases to €175 if the same procedure is done in a private hospital and can be as high as €843 in voluntary and regional public hospitals.
Around one-third of the VHI's customers with haemochromatosis have blood removed by GPs and the rest have the treatment in private hospitals.
Asked what efforts the VHI was making to have more of its members treated by GPs, a spokeswoman insisted that not all GPs want to provide such services.
"The reason we allow procedures in hospitals, as well as in primary-care settings, is to increase patient choice," she added.
The VHI can negotiate room rates with private hospitals. However, it has to pay much more for using rooms in public hospitals, under a price regime set by the Department of Health.
The department argues that public hospitals are run on taxpayers' money and it needs to see the maximum return from outside companies using these services.
There has been a 121pc increase in these side-room day procedures paid for by the VHI in the last decade.
Quinn and Aviva are also subject to side room prices imposed by public hospitals for these procedures.
- Eilish O'Regan Health Correspondent
Irish Independent
