Thursday, 10 February 2005
Dáil Eireann Debate
115. Caoimhghín Ó Caoláin asked the Tánaiste and Minister for Health and Children if she has received the fourth periodic report of the National Economic and Social Forum; and if she will make a statement on the matter. [34083/04]
Tánaiste and Minister for Health and Children (Ms Harney): I am aware of the report to which the Deputy refers. Section six of the report comments on the implementation of the National Economic and Social Forum report on equity of access to hospital care. The National Economic and Social Forum fourth periodic report raises several issues, mainly about equity of access to hospital care, in particular the “public private mix” in hospital care.
The report acknowledges and welcomes the many positive initiatives implemented in the Irish health service in recent years, for example, the increases in funding; the establishment and work of the national treatment purchase fund — particularly its fixing of a three month deadline for hospital treatment and its data gathering on hospital beds which has been commissioned; the Department’s commitment to a partnership approach; and progress on institutional and structural reform.
The National Economic and Social Forum report contains some wide ranging comments on the issue of equity of access to hospital care. The National Economic and Social Forum recognises the Government’s health service reform programme as providing a unique opportunity to achieve greater equity for the most vulnerable groups in our society. The Government intends to provide a policy and legal framework which ensures equity for public patients and enables patients and clients to access the services they need. Specifically, the national treatment purchase fund was set up to deal with waiting lists and particularly to ensure that those waiting longest receive treatment. Issues regarding the interaction between the public and private sectors and provision of hospital services is under active review and will be addressed, for example, in the context of negotiations on the consultant contract and the contribution which the private sector can make.
The report of the national task force on medical staffing sets out the changes needed in non-consultant hospital doctors’ work patterns; a series of reforms in medical education and training; the number of additional consultants needed and how they should work under a significantly revised contract. The report emphasised that change could not be achieved without reform of acute hospital services.
Taking this into account, the Government is committed to developing acute hospital services in a way that will command the confidence of people throughout the country. Consultant contract negotiations are paused pending resolution of issues related to medical indemnity arrangements. However, significant preparatory work has been undertaken on a draft consultant contract and management position paper.
The National Economic and Social Forum report comments on the ratio of acute hospital beds per head of population in Ireland compared to other OECD countries. At the outset it should be pointed out that the OECD advises caution in the interpretation of cross-country data on health. Health care systems differ significantly across the range of OECD countries. It should also be noted that the Irish data on the number of acute beds do not include the acute beds located in private hospitals in Ireland while some OECD countries include acute beds in private hospitals.
A comprehensive review of acute hospital bed capacity needs, Acute Hospitals Bed Capacity — a National Review, was conducted by my Department and published in January 2002. This review helped to inform the Government’s commitment to provide an additional 3,000 beds in acute hospitals by 2011 in the context of the health strategy. Since the publication of the bed capacity review funding has been provided for an additional 900 beds in acute hospitals throughout the country, 700 which were in place up to the end of January 2005. The remaining 200 are due to open by the end of 2005.
The report of the task force on medical staffing also recognised the important contribution that primary care can make to the provision of quality patient care and to reducing inappropriate demand on the hospital sector. The east coast area and the mid-western area, as the two phase one implementation regions, have prepared detailed plans for the development of primary care in order to support the reconfiguration of the hospital services in these regions and additional funding has been provided in 2005 to enable appropriate developments to commence.
The primary care strategy, Primary Care: A New Direction, sets out the direction for the development of primary care as the central focus for the delivery of health and personal social care services. This will enable patients to have direct access to a broad range of services provided by an integrated multidisciplinary primary care team in their local community.
The strategy also envisages the development of extended hours and out of hours cover for defined primary care services. Primary care planned and organised on this basis can lessen the current reliance on specialist services and the hospital system, particularly accident and emergency and out-patient services.
I have considered the concerns raised in the National Economic and Social Forum report about the increase in the drug payment scheme threshold. However, given the need to prioritise health spending in order to maximise the benefit over a wide range of pressing health expenditure options, together with the advantages of the scheme over the schemes it replaced, an increase of €7 per calendar month in the threshold is not considered to be excessive.
The drug cost subsidisation scheme and drug refund scheme were merged into the drug payment scheme in July 1999. To qualify under the old drug cost subsidisation scheme, patients had to be certified by their doctor as suffering from a condition requiring ongoing expenditure on medicines of £32, €40.63, per month. Under the drug refund scheme, families and individuals paid the full cost of their prescription medicines and claimed reimbursement from their health board of expenditure over £90, €114.28, in each quarter. Many families and individuals had very heavy expenditure on drugs and medicines and had to wait a further six weeks from the end of that quarter before they received a refund. This caused considerable cash flow problems for a significant number of families and individuals.
This does not happen under the drugs payment scheme. The primary aim of the scheme was to merge the best elements of the old schemes and improve the cash flow situation for families and individuals incurring ongoing expenditure on medicines. Since the introduction of the scheme, no individual or family has had to pay more than the monthly threshold, €85, for approved prescribed medicines. It means that families and individuals are able to budget for the cost of medicines. Regardless of the amount of their drugs bill no individual or family has to spend more than €85 per calendar month.
The scheme is for everyone. There are no qualifying criteria. Where expenditure by a family or an individual exceeds €85 per month on approved prescribed medicines, the balance is met by the State. The total reimbursement to patients under the previous schemes in 1998 was £75 million. This cost has increased to €204 million in 2003, the latest figure available, for the drug payment scheme.
The National Economic and Social Forum report also comments on the decline in numbers eligible for a medical card. At the beginning of January 2005 there were 1,145,083 people covered by medical cards, which is 28.32% of the current population. In 1998, there were 1,183,554 persons covered by medical cards, which was 31.95% of the population at that time.
The decline in numbers can largely be explained by a number of factors, including the changed economic circumstances of the population. These changed circumstances have meant that many people are no longer eligible for a medical card on means grounds. In addition to the above, the ongoing management and review of the medical card databases is a factor in the reduced numbers who held medical cards.
The cleansing exercise by health boards during 2003 and 2004 resulted in the removal of approximately 104,000 cards from the medical card register. Most of these cards would have been considered as normal deletions due to death, change in eligibility status or persons moving from one board area to another. A certain proportion were removed due to being duplicates or expired records for people over 70 years of age. A total of €60 million was provided in the 2005 Estimates to improve access to primary care by providing for up to 30,000 additional persons to become eligible for a medical card and free access to GP visits for up to 200,000 additional persons on low income.
Responsibility for the determination of eligibility of applications for medical cards rests by legislation with the chief officer of the relevant area of the Health Service Executive. Decisions are taken based on the income and individual needs of the applicant. This ensures that medical cards are granted to persons for whom the provision of medical services for themselves and their families would prove an undue financial hardship. The executive’s area chief officers have the discretion to grant a card on an individual basis, in cases where the income ceiling may be exceeded but where the circumstances of the case warrant such a decision.
One of the objectives of the health strategy is to prepare legislation to update and codify the legal framework for eligibility and entitlements in regard to health services. The Department is reviewing the existing legislation on eligibility and entitlement to services with a view to introducing legislation clarifying the position on those issues.
I welcome informed comment on health policy and the performance of the health system and the views put forward by the National Economic and Social Forum will be taken into account in the ongoing task of policy evaluation and future planning.
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