Perpetuating a private healthcare scam

  • Niall Hunter, Editor

Here's a pretty safe prediction amid all the recent prophecies of doom about the rising cost of healthcare.

Despite the dire warnings, no private hospital is likely to shut down anytime soon as a result of an expected 30% hike in health insurance premia caused by James Reilly's move to charge all private patients for accommodation in public hospitals.

The predictions of an insurance hike of this level happening as a result of this measure and this in turn leading to hundreds of thousands more abandoning their health insurance and forcing private hospitals to close are probably just a tad exaggerated.

So let's for the moment resist the urge to run out into the street screaming.

However, that's not so say that James Reilly's new measure is not decidedly dodgy.

The Health (Amendment) Bill 2013, which allows hospitals to charge private patients for occupying public beds, merely perpetuates and exacerbates of one of our longest-running healthcare scams.

And this perhaps, is something we really should be running into the street screaming about.

Our standard of medical care, if you can get access to it or afford it, is of a good quality in both public and private hospitals.

However, much of the system these days is run less like a service and more like a business.

This cash-generating model applies to public, as well as private hospitals.

It sometimes feels as if healthcare here is often sold like soap powder in a supermarket. Except it's a bit worse than that.

No other model of capitalism charges you twice for the same product. Yet this is what happens in our public hospitals, instigated and rubber-stamped by the Government.

Take private treatment in public hospitals.

The first question you must ask about this is why does this concept exist. They're public hospitals, after all.

The existence of private and public care within the same institution implies that there is a two-tier system within that hospital, which would surely be wrong.

The official line is that this isn't the case, and the policy now, we are told, is to ensure that there is no discrimination in public hospitals of in favour of private patients attending them in terms of levels of care or access to most services.

These is essentially no queue-skipping, we are told, when it comes to accessing most services in public hospitals. But it can take a long time to get access to these services.

Often, if a patient needs an operation and wants to avoid a waiting list, they will go privately outside the public system to get quicker access to some services, usually in more luxurious and less frenetic surroundings.

Well, fair enough, but if everything is equal in public hospitals, exactly why are people paying for health insurance plans that that cover them for private care in these hospitals, if they are entitled pretty much to the same level of care for free in those institutions?

And let's not forget that nowadays, with the cost of insurance rising, many people are downgrading their plans from those that cover for independent private hospital care to those that that only cover them for private care in a public hospital.

If there is essentially no major difference between private and public care in a public hospital, why do consultants get paid extra for treating private patients in these institutions, as many of them are entitled to under their contracts?

OK, you might say, private patients in public hospitals will at least get a semi-private or private bed and their attendant additional comforts, if these are available.

Well, not really...

In many public hospitals nowadays, there is very little difference in the quality of accommodation between a public and a semi-private or private ward or room.

I visited a semi-private ward recently in a major public hospital. It wasn't very luxurious, had six patients in it who shared one toilet, which wasn't very clean. It was no different really to the hospital's public wards. It may even have been of poorer quality than the public wards.

Sometimes, public hospitals have single private rooms, but these appear to be quite scarce.

Much of the semi-private and private accommodation in public hospitals might not provide much extra for the patient, but it does provide extra income for cash-strapped hospitals. So in terms of accommodation, patients are paying extra for next to nothing.

This recent comment on our Rate My Hospital service about a private room in a public hospital is a case in point:

"Cleanliness & training need serious attention. I had a private room and I feel I was treated poorer than public patients as my room was rarely visited by nurses - I had to ring the bell if I needed anyone and I simply feel that the bell should be for serious matters. My room was not clean prior to my admittance with full bins being the most obvious sign. In my three days there no-one cleaned / washed the floor in my room."

And the private care in public hospitals rip-off is about to get worse.

Often, for various reasons, semi-private and private beds may not be available, so a patient with health insurance is placed in a public bed. Under current rules, even if that patient is designated private on admission, they cannot be charged for such accommodation.

Until now that is.

Under James Reilly's new legislation, these patients, through their health insurers, can be levied hefty charges simply for occupying a public bed. They will get nothing for this extra bed charge that they are not already entitled to.

They are paying on the double for the same accommodation they would have got without charge if they were designated a public patient (remember, the entire population is entitled to free public hospital care, other than the €100 A&E and the daily €80 daily charge if they do not have medical cards).

With James Reilly's new charging rules, patients or their insurers are paying extra for nothing.

If this was happening in another sector of society, the full wrath of consumer law would be brought to bear on those responsible.

But we seem to accept this sort of sharp practice in our healthcare system just because it seems to make some sort of Kafka-esque sense to those running it, simply because it generates income for the under-funded public hospital.

The hard-pressed taxpayer is paying on the double, or even treble for this State-backed sleight-of-hand.

A public bed in a public hospital is totally funded by the taxpaper. If an insured person has the temerity to occupy such a bed which he or she has already funded through their taxes, they will now also be charged up to €1,100 per day, through their health insurer, for the dubious privilege.

And the new charge will lead to them probably paying more for their health insurance premia on the top of the by now regular increases, as it is the insurers who will be forced to fund this State-backed money-making venture, although not perhaps to the tune of a 30% premium hike.

By the way, those who purchase the more expensive type of health insurance to cover for independent private hospitals are also essentially paying twice for what should be the same thing.

They fund the public system through their taxes, but they feel they have no choice but to bypass it most of the time in order to get better access to care, and perhaps to avoid the undeniable squalor that exists from time to time in some public hospitals.

Some might call this 'choice' and the 'free market', but many of those who make sacrifices in order to afford more expensive health cover feel they haven't got much choice in the matter.

We are frequently lectured about getting value for money from our health system. Those running the health system should practice what they preach and stop ripping off taxpayers.

Perhaps a way of ending this rip-off will be through the introduction of universal health insurance.

If all the money taxpayers are currently paying in health insurance in order to get the health services they should already be getting for their tax dollars was instead pumped back in to fund a better State-run system, would it make things better?

That's a good question, and the answer at this stage is we simply don't know.

If there was no distinction between private and public care, if the entire population was insured and could access care on the same basis, and if the cost of this insurance was controlled, this would surely be preferable to the current dishonest mess.

If UHI is run properly, such a system could possibly work well. However, under details revealed to date, too many vested interests in this new healthcare 'market' would stand to gain too much to allow it to work equitably, unless it is properly regulated.

Proposals for 'money following the patient' in a system run by health insurers, and with hospitals acting independently within trusts, have a fair deal of scope for abuse and inefficiency if the system is not regulated properly.

And we don't have a great track record in this country when it comes to State regulation.

Time will tell on whether we can really trust the reform of our health service to a Government that thinks it's OK to charge hospital patients extra and give them nothing in return.





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