Wednesday 11 December 2019

Hospitals to charge private patients for use of public beds

Move likely to prompt rise in premiums and increased hospital waiting lists

Health Minister Leo Varadkar
Health Minister Leo Varadkar
Charlie Weston

Charlie Weston

PATIENTS with private health insurance will be charged for using a public bed in a public hospital for the first time.

Hospital managers have been told to bill insurers for patients with private cover - even if they end up using a trolley in a corridor. And the move is likely to lead to higher healthcare premiums for families, as health insurers have not budgeted for it.

It is also expected to increase waiting lists, as hospitals are effectively being encouraged to extract a whole range of charges from those with health insurance.

There are growing fears that the move is likely to see hospitals prioritise treating those with cover.

The Health Services Executive (HSE) admits that charging people who have health insurance for a public bed conflicts with the State's health policy and could be in contravention of the law, a copy of a memo seen by the Irish Independent makes clear.

The memo from the HSE finance chief also tells hospitals to charge people with health insurance:

• Even when they are admitted on an emergency basis.

• Whether they are treated on a bed, a therapy chair, recliner or a trolley.

• Whether they get a "designated" bed or a public bed.

• Whether they are treated in a ward or a corridor.

The memo was described by one industry expert as being "a blitz on the health insurance sector".

"Insurers did not expect this or make provision for it," said Dermot Goode, who runs a health cover website.

But the Department of Health rejected these claims, saying the memo was only setting out rules that came in at the start of the year.

Previously, insurers only paid out on the basis 20pc of beds in the public system that were designated for private patients.

But the recent memo was sent to the managers of every hospital in the country by HSE chief financial officer Stephen Mulvany.

In it he states: "If for whatever reason a private elective patient is placed in a public bed a charge must be raised."

The memo says this charge must be raised "notwithstanding that a breach of the policy and SI (statutory instrument) 135/1991 has taken place".

This is reference to a statutory instrument, which sets out that a certain number of private beds must be "designated" in public hospitals.

The statutory instrument bans people with health insurance, who are admitted and have their treatment paid for by their insurer, being given a public bed.

It also sets out that public patents must not be given a bed designated for those with health insurance.

The memo acknowledges that statutory instrument remains in force.

Health experts said this would again drive up premiums, forcing thousands more families to jettison cover.

They also warned it could send waiting lists surging upwards as hospitals will be incentivised to treat private patients.

A spokesman for Health Minister Leo Varadkar (inset) said insurers must have factored the extra cost in already, as they were made aware of changes to the charging system.

However, the department had no comment on hospital managers being told to impose charges even when private patients end up in public beds.

Health insurance expert Mr Goode said the extra charges imposed on insurers were not expected - and would send premiums up.

"Insurers did not expect this or make provision for it. This is a blitz on the health insurance sector," said Mr Goode of TotalHealthInsurance.ie.

Mr Goode said the memo would mean that people with health insurance could end up having their insurer charged for a bed they did not get.

"This implies that private patients with insurance are to be charged differently to public patients," he said.

But a spokesman for Dr Varadkar rejected the claims that premiums would rise, and said it would not mean waiting lists would get longer.

He insisted the charges would not apply to people with insurance admitted to A&E.

"Insurers would have known about this new system of charges since mid-2013, well before they set their premiums for 2014. There would not appear to be any reason for new increases to arise as a result," he said.

He added that the comptroller and auditor general (C&AG) had found almost half of in-patients being treated privately by consultants were not paying the designated charge to the public hospital in which they were being treated. This was because they did not occupy a designated private bed.

"The matter was also raised by the Troika and represented a significant loss of income to the public hospital system and to taxpayers," the Department of Health spokesman said.

He added that the HSE wrote to hospitals for clarification purposes over the summer.

"This letter referred to the new system which has been in place since January, and does not denote any new or further changes," he said.

"This matter does not relate to emergency departments, and has nothing to do with waiting lists."

Irish Independent

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