GUIDELINES restricting treatment criteria for private patients with asthma and other medical conditions were issued in error and have now been formally withdrawn by the Voluntary Health Insurance (VHI) board.
Doctors have said the restrictions posed a “significant risk” to the health of patients.
The Irish Timesunderstands the new medical admission ground rules, detailed in a schedule of professional benefits sent to consultants and other doctors on July 1st, restricted the basis on which patients could be admitted to hospital with certain medical emergencies.
In cases of acute asthma, rather than allowing the doctor to decide whether hospital admission was required, the new rules specified that the patient’s costs would only be covered if the episode of acute asthma had been unreponsive to two outpatient treatments with nebulised drugs (treatment given directly to the lungs) and if the person had a specified breathing measurement of less than 50 per cent of normal.
“This is a serious concern because it limits a physican’s judgement for hospital admission for such patients until they are potentailly in real trouble with their asthma attack”, a senior consultant said.
One to two asthmatics die each week from an acute asthma attack.
Doctors are also concerned that in a situation where a person signs a form prior to hospital admission confirming they wish to be treated as a private patient, restrictive criteria such as those outlined for acute asthma could leave the patient having to pay all or part of the cost.
“Our concerns aren’t in relation to renumeration for consultants, but that these restrictions take away entitlements currently enjoyed by patients. Our members are concerned the VHI haven’t consulted with their subscribers or asked them how they feel about these changes,” Dr Sean Tierney, vice president of the Irish Medical Organisation and a consultant surgeon at Tallaght hospital, said.
But a spokeswoman for VHI said it was in the process of clarifying medical admission ground rules and that in the meantime the 2008 rules continue to apply. “The changes were contained in the July 1st schedule but were incorrect. The listed examples were of medically appropriate admissions only. They were never meant to be a definitive list,” she said.
Confirming the new criteria would not now apply, the spokeswoman said, “differences between individual patients and medical discretion have always been and continue to be respected by VHI Healthcare”.
Apart from changed criteria for the admission of medical emergencies, the 2009 proposals are also understood to have included restrictions on whether a person could be admitted the night before an operation and that an entitlement to pre-operative assessment would be based on a disease-specific approach rather than one recognising the growing complexity of individual cases. These restrictions will not now apply.
VHI Healthcare has over 1.5 million subscribers.