The Eastern Regional Health Authority agreed last night to push ahead with plans to curb the growing influx of patients from other regions coming to its hospitals for treatment they can readily access in their own areas.
A report on the extent of the problem adopted at the authority's monthly meeting last night put the estimated cost of treating patients from other health board areas in 2001 at €174 million. These patients were also "placing pressure on limited resources in the east," the report said.
Members were told that some 270,000 bed days were used in hospitals in the east by patients from outside the region in 2001. This was the equivalent of 22 per cent of total bed days in eastern region hospitals. It was also the equivalent of filling a 737-bed hospital for a full year.
Furthermore, 28,000 patients from outside the region were admitted for day-case treatments to hospitals in the east in 2001.
"Day-case treatments for patients from outside the region have grown considerably in recent years and have more than doubled from 13,500 in 1994. This is despite the significant investment in staff and facilities outside the east and the fact that day-cases tend to be lower in complexity than inpatient treatments," the report said.
Treating day-case patients from outside the region cost €23 million in 2001 and these cases represented more than one-fifth of all day-case treatments carried out in the east in 2001.
The report, drawn up by the ERHA and presented by the authority's director of planning, commissioning and change, Mr Jim Breslin, expressed concern at the fact that many of these referrals were inappropriate and affecting equity of access for patients in the east. It said treatment rates were lower for the population of the eastern region than for the rest of the country.
Moreover, it drew attention to the fact that many of the referrals from outside the region were of private patients.
"Private patients make up 27 per cent of non-east inpatients compared to 22 per cent of eastern region inpatients," it said. It was important to ensure patients in the east were not disadvantaged by private patients from outside the region "enjoying favourable access to services in publicly funded hospitals in the region".
The situation in relation to inappropriate admissions was most acute when it came to elective or planned admissions, the report said. For example, people from the midlands, north-east, north-west and south-east had considerable numbers of tonsillectomies performed in Dublin hospitals but those living in the east were 35 per cent less likely to receive a tonsillectomy than those living in the midlands.
The same was true for hip operations. "Of all the hip-replacements performed on those living in the west, 12.5 per cent are carried out in hospitals in the east. This is despite the fact that, if living in the east, you have only 60 per cent of the likelihood of receiving a hip replacement as a person from the west."
Yet, it said, delays in accessing elective surgery "are at their most unacceptable in the eastern region", with 12,326 patients on inpatient waiting lists, which is 67 per cent of the number of patients waiting nationally.
"Probably the most significant cost for the eastern region in treating patients from outside the region is the opportunity foregone to utilise scarce manpower, beds, theatres and other facilities to address the needs of patients from the east waiting for treatment."
The report noted that many elective referrals from outside the region were made directly by GPs with no involvement of the local health board and the ERHA wanted this stopped. It proposed that all GPs should now be asked to refer patients to their local specialist at their local hospital first and only then be referred to the east if appropriate treatment cannot be provided locally.
"The reason for non-treatment locally cannot be based on the financial position of the referring institution or health board."
Implementing the new procedures will require the co-operation of health boards and hospitals, the ERHA said, but it hopes to begin discussions with all parties immediately in an attempt to iron out the difficulties.
The report acknowledged that some patients would continue to be referred to Dublin hospitals for specialist services not available elsewhere and said it was essential the region was properly reimbursed for this workload.