Patient confidentiality row led to withholding of drug payments

A row over patient confidentiality between the Health Service Executive and the Mater hospital in Dublin led to the withholding of millions of euro in drug payments last year.

The HSE says the hospital must provide details of patients’ PPS numbers, or an alternative identifier, before it will reimburse the cost of HIV medicines provided to patients.

Doctors at the hospital view the HSE’s demand as a breach of confidentiality and their human rights obligations. Hospital management has separate concerns it will not be reimbursed for patients attending from outside its normal catchment area.

Many HIV patients come to the Mater for treatment because they believe they would be discriminated against in their local area, according to doctors in the hospital, including many asylum seekers.

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Doctors, who say they often treat patients without identity papers, complained to hospital management about “meddling” by HSE administrators.

Health records

The Mater treats about 1,200 HIV patients, at an average cost of €8,000-€10,000 a year for their medication. Many lead chaotic lifestyles, according to doctors, so maintaining personal health records and following drug regimens can be a challenge.

The HSE's Primary Care Reimbursement Service (PCRS), in correspondence to the hospital, said there was a need to use the PPS number as a patient identifier in all transactions processed by the service. The view of the Data Protection Commissioner was that the use of the PPS number was "entirely reasonable", and it was also acceptable to the Department of Social Protection.

Asked this week whether the HSE required a patient’s PPS number for all PCRS transactions, however, the HSE said it did not.

“The PCRS requires patient identity for all reimbursement of services using exchequer funding in respect of those patients. PPS number is required in certain circumstances in the absence of national health scheme identifiers [eg a medical card number, drugs payment scheme number] where this is more convenient for the patient or service provider.”

A medical card number or similar was used “in the vast majority of cases”. Where a patient has no identifying number, PCRS is not able to reimburse the service provider until the patient’s eligibility for exchequer-funded services in Ireland is established.

The PCRS was not currently reimbursing for HIV service provision, the statement confirmed, but this was under review. A spokeswoman for Ireland East Hospital Group, which includes the Mater, said clinicians were in dialogue with the PCRS to resolve concerns.