Colm McCarthy's proposals to raise A&E charges to €125 in public hospitals would make it cheaper to go private, writes MARESE MCDONAGH.
IT COULD soon be cheaper to attend an A&E department in a private clinic rather than go to the emergency department of your nearest public hospital.
One of the more controversial proposals in the McCarthy report was the suggestion the charge in public hospitals – which rose from €66 to €100 in the Budget – should be further hiked to €125.
Consultants warn that some patients will be forced to attend GPs rather than go straight to the emergency department, in a bid to avoid such a prohibitive charge. In some cases the resulting delay in treatment could be life-threatening, they say.
Campaigners also say the increase will be a significant boost for the private health sector, whose rates will seem increasingly attractive.
Patients at the A&E department of the Galway Clinic are charged an initial consultation fee of €90 for “minor injuries” and €120 for “major injuries”.
The initial consultation fee at the five VHI Swiftcare clinics is €115. Since January this charge has been automatically reduced by €75 to just €40 for members of the insurance company’s LifeStage Choice plans. Going private could soon be more economical.
“The Government should hang their heads in shame if they allow this to happen,” said Janette Byrne of Patients Together, saying private clinics are already “cherry picking” the type of conditions they cater for.
She said Minister for Health Mary Harney has expressed concern about people attending A&E departments unnecessarily and there now seems to be a policy of “trying to keep people away from [public] hospitals”.
Byrne says the emergency department is the last place most patients want to go as they fear long waits on trolleys in less than ideal conditions.
While those with medical cards don’t have to pay the A&E charge, Byrne says many of the 52 per cent struggling to pay for private health insurance will find it a charge too far. “It’s appalling that we are being pushed more and more towards the private health sector,” says Byrne. “We keep reading about ministers and the elite presiding at the official opening of yet another private clinic while wards are being closed in the public sector. I believe the ministers should be forced to officiate at the closure of wards and theatres.”
President of the Irish Association for Emergency Medicine Dr Fergal Hickey is adamant the increased charge will do nothing to discourage non-emergency cases from clogging up the public emergency departments.
Dr Hickey said the association expressed strong reservations before the charge was increased in the Budget and he said if anything he feels more strongly now that increasing the charge “makes no sense”.
Dr Hickey said in many cases it was “entirely inappropriate” for patients to consult a GP before going to the emergency department, causing delays which could be dangerous. If a chest pain means a heart attack, the patient who consults a GP first will wait longer for life-saving drugs to be administered, he said.
Dr Hickey also says “some of he greatest abusers” of the system are those who do not have to pay AE charges. Earlier this year it was reported that the number of people attending hospital emergency departments had fallen by almost 5 per cent following the Budget increase.
Dr Hickey says all cases are “triaged” as soon as they arrive in the emergency department to determine which are most urgent, so non-emergency issues are put at the back of the queue and don’t cause delays for those who are critically ill.
Crucially, the consultant says the proposed €125 charge could cause people to wait too long to go to the hospital. “You can imagine a situation where a child has a rash which turns out to be the most serious form of meningitis but the parents decide to observe the child for one more hour because they can’t take the €125 hit. That could turn out to be life threatening,” he said.
Dr Hickey also said delays which lead to worse outcomes will end up costing the HSE more because people may be more dependent or may spend longer in hospital. “I think emergency care should be free at the point of delivery but if there is a charge it should be nominal and should be more fairly applied.”
Dr Tom Nolan, a Co Clare GP, said a €125 A&E charge would be “morally unjustified”. However, Dr Nolan supports the idea of a €5 prescription charge, mentioned in the McCarthy report, but says the long-term illness scheme should be extended so people with arthritis and asthma, for example, don’t incur ongoing and frequent charges.
“I believe that a prescription charge would result in better medicine as it would focus doctors’ minds on finding something other than medication to help the patient,”he said.
Pharmacists disagree. Acoording to the Irish Pharmacy Union (IPU) the community pharmacy sector is already “in crisis” because of Mary Harney’s plan for a 34 per cent reduction in fees under the Community Drugs Schemes (CDS) . It says the McCarthy proposals would create “further chaos” in the system. “The pharmacy sector understands the need for change and reform, but this must be done through a partnership approach with service providers,” said an IPU spokeswoman.
It is understood that over 1,000 pharmacists have written to the HSE saying they will no longer dispense medicines under the CDS from August 1st.