Dáil Éireann - Volume 592 - 09 November, 2004
Adjournment Debate. - Health Board Services.
Dr. Upton Dr. Upton
Dr. Upton: I welcome the opportunity to raise this matter on the Adjournment.
My constituents, an elderly couple whose only income is their invalidity pension, find themselves caught in a health care trap between the cost and availability of private care and the famine of available health care for public patients. This couple has no savings and very limited borrowing capacity. Any borrowing they can access via their credit union places a very severe financial burden on them to repay a loan.
The wife had a number of medical procedures carried out at St. James’s Hospital, which were unsuccessful. She had ongoing visits to doctors and stays in the hospital, was constantly in pain and found herself on ever-extending waiting lists for treatment. Finally, the consultant advised that he could do no more for her. A number of emergencies occurred in the midst of all of this.
Her husband decided, having carefully considered the cost, that consulting a private consultant and going as a private patient was worthy of investigation and he undertook to speak to a consultant in St. Vincent’s Hospital. The consultant decided that treatment was a possibility and that he would undertake to carry out the appropriate procedure.
At this point the husband discussed the possible cost with the hospital. He was told that the daily cost would be of the order of €225. He decided to borrow this from the credit union and worked out carefully how he would make the repayments. The couple decided together that this was worthwhile and that the consequent improvement in her health would be worth the financial strain of the repayments.
However, they were genuinely unaware that the cost outlined to them referred only to the hospital bed, that it did not include the cost of any specialist tests, the anaesthetist, laboratory reports and so on. All of these additional costs had not been referred to when they made their inquiries. A number of complications arose and she required not one but three weeks in hospital. They now find themselves with an outstanding bill of €7,500. This has been going on since 1999. They are in no position to pay this bill. However, they defrayed the costs of the consultant, the anaesthetist and so on to the extent of €2,500.
 This couple acted entirely in good faith. They planned carefully for the hospital as far as they were aware. They were unaware of the complexities of private hospital treatment for the simple reason that they had never had the opportunity to avail of it previously. To add insult to injury in St. James’s Hospital on a previous occasion, the patient needed a CAT scan. When her husband telephoned the hospital to make an appointment as a public patient — and his consultant advised him that it was urgent — he was told that there was a waiting list of approximately 18 months. Again, he decided he would save up the cost of a private consultation. He telephoned the same hospital to make an appointment as a private patient and was asked what time the following day he would like to have the appointment.
In a general way, this points up the gross inequality of the private and public facilities and waiting times. It is totally unacceptable and is placed in sharp focus by the dilemma in which this couple find themselves. It is particularly unacceptable when an elderly couple must worry and fret over the cost of health care when illness is already a major burden for them. They now find themselves with an enormous bill that they cannot hope to pay.
They have received a number of reminders from St. Vincent’s Hospital as well as reminders more recently from a firm of solicitors acting on behalf of the hospital, and they are now under constant stress because of this bill hanging over their heads. Any consultant they met did not suggest to them that they might have been eligible for the national treatment purchase fund. They would have been more than happy to avail of this if they had been informed of it.
I ask the Minister to review this case sympathetically and to arrange to waive the outstanding amount that this couple has been billed for. They are unable to pay it now or in the future because of the constant strain on their already very meagre resources through ongoing ill health.
Mr. T. O’Malley Mr. T. O’Malley
Mr. T. O’Malley: I thank Deputy Upton for raising this matter on the Adjournment.
I understand the person to which the Deputy referred received treatment in a private hospital and is seeking assistance to cover the cost involved.
I should like, first of all, to point out to the Deputy that responsibility for the provision of health services to residents of counties Dublin, Kildare and Wicklow rests with the Eastern Regional Health Authority.
Under arrangements for public hospital services introduced in June 1991, everyone, regardless of income is entitled to public hospital and public consultant services subject only to modest statutory charges, from which medical card holders are exempt. At present these charges are set at €45 per night, subject to a maximum of €450 in any twelve consecutive months, in respect of inpatient public hospital services.
 Alternatively, one can opt to be the private patient of both the consultant and the hospital. Any patient, whether a medical card holder or not, who opts for treatment in a private hospital or as a private patient in a public hospital is liable for the costs relating to such treatment. The 1989 Commission on Health Funding recommended on the grounds of equity that patients make an explicit choice between public and private health care.
Under the Health Act, 1970, the determination of eligibility for health services is the responsibility of the chief executive officer of the appropriate health board. I would add that health boards have discretion, in cases of exceptional need, to provide assistance to individuals where undue hardship would otherwise be caused. In this regard my Department has forwarded the case referred to by the Deputy to the Regional Chief Executive of the Eastern Regional Health Authority for consideration.
I will raise the matter with the CEO because I understand the hardship involved for an elderly couple caught in this situation, having come across such cases previously.
Dáil Éireann 592 Adjournment Debate. Health Board Services.