Consultants should only see public patients in public hospitals, committee hears

The Government should move quickly to introduce a new contract for hospital consultants permitting them to see only public patients in public hospitals or the costs of ending private medicine in State hospitals will get larger, the Oireachtas health committee has heard.

Dr Donal de Buitléir said there was no point in the State continuing to issue contracts to medical specialists with private practice rights as these would have to be bought out in the future.

Dr de Buitléir chaired the recent expert group which examined the removal of private practice from public hospitals - a key element of the proposed Sláintecare health reforms.

He told the committee on Wednesday that his group concluded that ending private activity in public hospitals was “technically feasible”.

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He said it was now a question for the political system as to whether this proposal should be implemented.

Committee members Stephen Donnelly of Fianna Fáil, Alan Kelly of Labour and Louise O'Reilly criticised plans to include facilities for private patients in the new maternity and paediatric hospitals being developed by the State.

Dr de Buitléir said if the plans to end private medicine in public hospitals were implemented, such facilities would be redundant in 10 years.

Higher taxes

He said the cost of removing private medical practice from public hospitals would lead to higher taxes but lower health insurance premiums.

Dr de Buitléir said that it was unfair that those with private health insurance or who could pay out of pocket were able to access services in public hospitals quicker than those who did not have private health insurance or who cannot afford to pay.

Dr de Buitléir said that almost 30per cent of total hospital activity was funded privately – “a situation comparable only to the US”.

He said his group estimated that the cost of removing private medicine from public hospitals would, at the end of a ten-year implementation period, be approximately € 650 million per annum.

“The main element of this is the private income of hospitals (now just over €500 million) paid mainly by insurers. This income is declining in any event due to the campaign by insurers to inform patients that they gain no advantage from using their insurance when admitted via the emergency department of a public hospital. While the loss of this income will result in a cost to the Exchequer, people are already paying for this in the form of higher insurance premia. The loss of this income will result in higher taxes but lower insurance premia. Even if there is no change in the existing system, this source of income will decline.”

He said the income to hospitals from insurers was unstable and was falling .

He said it would be “very risky to rely on this income continuing into the future”.

He said it was important to note that €650 million was the annual cost which arises after all private activity is removed.

In the initial years of implementation, the costs will actually be quite modest, primarily arising in relation to the additional expenditure on consultant pay.”

Sláintecare

The expert group recommended that all new consultant appointments should be to a Sláintecare contract which would allow them to conduct only public activity in public hospitals.

It proposed that pay cuts imposed for medical specialists appointed after October 2012 should be reversed for those appointed to the Sláintecare contract who would have a starting salary of €182,000.

Dr de Buitléir argues this would leave such consultants in the top one per cent of earners and that when public service pensions were taken into account, these positions would be attractive.

The recent expert group proposed that existing consultants should be offered a “contract change payment” to move to the new Sláintecare contract.

It suggested a special derogation from pay service caps be put in place to facilitate recruitment to highly specialised posts in a very limited number of cases.

Dr de Buitléir forecast that the vast majority of patients being treated privately in public hospitals would in future become public patients because either they were admitted as emergencies or required complex care, multidisciplinary or maternity services which were not available within easy reach in the private sector.