Health (Amendment) Bill 2013 will create an unfair deal

Posted in Blog by saraburke on July 18, 2013

There has been a worrying lack of debate on the Health (Amendment) Bill 2013 which, if passed, will place significant financial burdens on some of the most vulnerable in Irish society, see here from Medical Independent column from  18 July


The Government is planning to introduce new charges and increase existing charges for all aspects of public health provision where one needs to stay overnight for care. This includes increased charges for public and private patients in public hospitals, new charges for people with disabilities in residential care, additional payment for older people with assets in residential care and for anybody who avails of respite care.

In effect, the Government is actively planning to hit hardest those in hospital and residential care who need care the most. These changes are being introduced by the Health (Amendment) Bill 2013 which is very quietly weaving its way through the Oireachtas with no public and political debate.

Legislating for this 25-page Bill should be illegal. It is incomprehensible to any reader, detailing a range of amendments to the 1970 Health Act without specifying what aspects it is amending of the 1970 Act.

A close read of the document reveals the following. The charge for treatment in public beds in public hospitals will increase from €75 a day, (for a maximum of 10 days – €750 a year), to €80 a day (with a maximum of €800 a year).

However, the legislation also means that, with the stroke of a pen, the Minister for Health could increase the total annual charges for public patients in public hospitals from €800 to over €4,200 a year. This will have the biggest impact on those with no medical card. Medical card holders are waived from such charges and those with health insurance are covered.

Under the Bill, the Nursing Home Support Scheme (NHSS) – the so-called Fair Deal scheme – is increasing the claim to assets over €36,000 from 15 per cent to 22 per cent of their value. The Bill also specifies that the “HSE may outsource the operation and administration of the NHSS”. When asked for clarification on this, the Department of Health said they had no plans at present to outsource it. So why on earth is it in there then?

The Bill also applies the NHSS to people in residential care with physical, sensory, mental health and intellectual disabilities; in effect it will introduce mandatory charging for residential care for people with disabilities for the first time.

Currently, people with disabilities in residential care contribute to the cost of their care, but the amount varies depending on their place of residence. Some charge the NHSS equivalent of 80 per cent of the current income. For most people with disabilities this means 80 per cent of their weekly social welfare payment of €188. However, many pay less as the current charge is meant to take into account the additional cost of disability.

Introducing the NHSS to people with disabilities means that the cost of disability will be ignored and their options of independence denied. It also means that for the first time, people with disabilities will have to contribute from assets worth more than €36,000.

Critically, the NHSS scheme for older people is meant to be about choice – such choice does not exist for people with disabilities who have to go to their local provider. This Bill is going to make people with disabilities pay more for the cost of their residential care without any choice about where they go for their care – a very unfair deal.

The Bill would also legalise charging for respite care if more than 30 days in a year are spent there, making this lifeline for some people unaffordable.

The only bit of this Bill that has got any public hearing is the increased charges for private patients in public hospitals. This is a way for government to earn more money  quickly – €60 million this year and €120 million next year. However, it is totally contradictory to the Government’s policy of money follows the patient where hospitals are paid for individual treatment rather than a block charge (such as the proposed one between €730 and €1,122 a day).

When asked for the rational for these charges, the Department of Health said “they are based on the average economic cost”. This new charge will incentivise indebted public hospitals to treat more private patients, as they are more lucrative, thus making it harder for public patients to gain access.

If private insurance companies and private hospitals are to be believed, it might also bankrupt them, thus jeopardising the introduction of the cornerstone of government policy – universal health insurance.

This Bill is unethical in its process and motivation. Quite simply, its makes a messy, complex system of payments for essential care messier and more complex, especially for poorer, older and disabled people.


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