A Government plan to remove private care from public hospitals could be challenged under the Constitution by hospital consultants, the State-owned health insurer VHI has said.
The VHI said it supported the principles of the Sláintecare plan, which involves a move towards a universal single-tier health and social care system. However, it warned that challenges in implementing the new strategy could, if not properly addressed, “undermine both the public and private systems of healthcare”.
VHI made its comments in a submission to a review group established by the Government which is examining the implications of removing private care from public hospitals.
Sláintecare is the 10-year programme to transform the health service into a single-tier system where patients are treated on the basis of need. One of its key recommendations is that private care should be removed from public hospitals. It said holders of private health insurance would still be able to purchase care from private healthcare providers.
VHI said it did not believe that the Sláintecare recommendations would lead to a substantial reduction in hospital waiting lists. “The most likely result of the removal of private reimbursement from public hospitals will be the re-labelling of private patients as public, with no overall reduction in the list size.”
Existing contracts
Furthermore, it said there was the prospect of legal challenge by consultants who carry out private work at public hospitals under their existing contracts.
“Consultants’ public service contracts would need to be substantially amended to prohibit consultants’ private practice taking place in public hospitals. While this could ultimately be achievable by negotiation and agreement, issues such as prior investments in consulting rooms and long-standing attachments to hospitals where practices have been built over many years would likely to be contentious issues, and could potentially give rise to arguments framed in constitutional terms.”
VHI said there were more than 800 consultants with contractual rights to work both in public and private hospitals. Under the Sláintecare reforms these would have to make a choice on whether in future to operate exclusively in public facilities. “The potential loss of up to 804 consultants could create a crisis for the public sector.”
VHI argued that prior to removing private care from public hospitals the Government needed to address a number of key issues. These included:
* consultant remuneration to compensate for loss of private income;
* capital investment in consulting rooms;
* the availability of theatres and appropriate facilities for day-care surgery;
* the availability of diagnostic equipment and allied services;
* extra support staff (secretaries, practice nurses, technicians);
* extra public beds;
* significant investment in IT infrastructure;
* extra investment in training and research for consultants.
Relationships
VHI said it was very clear that almost all of VHI members who elected to use their cover to avail of public hospital care could have gone to private institutions. It said they chose to opt for the public hospitals even after changes put in place in 2014 meant access to private rooms was unlikely. It suggested that this was for convenience, proximity to emergency care and relationships with consultants who only practised in certain hospitals.
VHI said the State could face having to pay out a considerable amount of compensation if consultants with existing contractual rights to treat fee-paying patients had these removed under reforms.
In a separate submission, the Health Insurance Authority (HIA), which regulates the sector, forecast that ultimately developments in the health insurance industry would be influenced by the actual progress achieved in putting in place the Sláintecare reform programme, and, in particular, by the extent of improvements made in the level of access and the scale of waiting lists for elective or non-urgent treatment in public hospitals.
The HIA said Sláintecare would require a substantial increase in current Government spending on healthcare, and that this would almost certainly lead to a rise in taxation.
“There is little doubt that additional spending of at least €1 billion per annum and probably considerably more than that would be required in the public hospital system to achieve the Sláintecare target waiting time of a maximum of 12 weeks for elective treatment in public hospitals.
“In addition, the Government would have to fund the loss to public hospitals of private patient income of approximately €600 million per annum at current prices.
“Finally , the Sláintecare report itself emphasises the need for front -loading of spending and activity to achieve good progress in reducing the current waiting lists for treatment and consultations.”
Tax relief
Addressing the risk of people scrapping their health insurance once Sláintecare is implemented, the HIA said that to mitigate risks to the market while removing private care from public hospitals existing tax relief on insurance premiums should not be reduced any further.
It added that the Government could clarify whether consultants would be permitted to work in private hospitals after fulfilling their contractual obligations in public facilities.
The HIA suggested it was reasonable to expect if private care existed only in private hospitals that a smaller insurance market would continue as long as a return could be made. It said the State-owned VHI would continue in operation in any event.
However, it said it was impossible to predict the size that the health insurance market would be in such a scenario.
