Madam, - I refer to your lead report of last Monday, June 6th on the decision by the Competition Authority that the Irish Hospital Consultants Association has contravened Section 4(1) of the Competition Act 2002 in its arrangements for professional fees with health insurance providers.
Over a decade ago, there was enormous political, consumer and media pressure on the profession to end the practice of balance billing and agree a schedule of fees with VHI, which was then the only health insurer in its market.
Through the early 1990s the IHCA negotiated with VHI, and subsequently with BUPA Ireland, and reached a position whereby patients being admitted to hospital were guaranteed comprehensive insurance for all professional fees levied by consultants. Patients, or their next of kin, who were worried about their medical condition on admission to hospital did not have to worry about bills that might arise. All of the information at our disposal suggests that this arrangement was acceptable to everybody, especially patients.
However the Competition Authority has ruled that these arrangements constitute fee-fixing and militate against competition in the provision of services in the health market. There is a view that the so-called health market is not an open market like that for other services.
The provision of hospital services and the number and type of consultants appointed around the country is (quite rightly) the responsibility of the Department of Health and the Health Service Executive. Hospital consultants, as their name suggests, cannot set up shop on any high street like other professionals or service providers. They require a hospital base in which to treat patients. This they get through a public appointment or by gaining admitting rights to a private institution.
Patients will now have the opportunity to "shop around" for consultant services. How practical this suggestion is may be open to question. On any given day, 70 per cent of patients who are admitted to our public hospitals are emergencies. In an average week, 8,000 emergencies are admitted to our hospitals; 50 per cent of them are private. Somehow I cannot imagine the next of kin of a patient with severe chest pain chasing through the Golden Pages looking for quotations from cardiologists. The reality is that not only does the emergency patient not have a choice of consultant but in many instances he/she will not have a choice of hospital. The patient will be taken to whichever hospital is deemed appropriate by the ambulance crew.
In correspondence to the IHCA's solicitors on May 6th the Competition Authority stated: "The case team presented its preliminary view to the Authority that a breach of Section 4(1) of the Act has occurred. Further investigation is, however, warranted in particular with respect to the appropriate remedies prior to a formal decision being taken by the Authority."
Whatever further investigations were necessary were completed by May 30th when the Competition Authority again wrote to our Solicitors stating that "a breach of Section 4 (1) of the Act has occurred". Obviously this association has every intention of operating within the confines of the Competition Act 2002. We have therefore terminated all discussions with health insurance providers and it remains to be seen what arrangements, if any, will apply from July 1st next when the current two-year agreement between the profession and health insurers expires.
Should there be a return to balance billing, readers are asked to remember that in the interests of competition and the maximisation of service provision, the seemingly sensible arrangement which applied for over a decade is now deemed to be illegal. - Yours, etc,
FINBARR FITZPATRICK, Secretary General, Irish Hospital Consultants Association, Dublin 14.