Restricted access to treatments and new charges mooted in internal Department of Health report, writes MARTIN WALL
AN INTERNAL Department of Health report has set out highly controversial options for restricting access to health services and to put in place new charges or co-payments.
Among the measures proposed is new legislation which would specifically state that the HSE has a responsibility to provide services only within the limit of its resources.
Such a proposed Bill would make it clear that the individual has no guarantee of personal access to services and it would rule out the right of members of the public to bring civil proceedings where they believed health authorities had failed in their duties to provide services.
The Department of Health document also suggests that charges could be introduced for non-medical patients for some cancer screening services and for any subsequent treatment provided. It proposes that co-payments could be introduced for patients receiving home care packages or home help services.
It says that State subsidies on the cost of drugs and medicines provided to private patients under the Drug Payment Scheme could be “more graduated”, with those on higher incomes having to pay more than those earning less.
It proposes that services such as warfarin or diabetic clinics – which are currently provided in acute hospitals or in “hospitals in the home” – should, for health policy reasons, “be provided on a whole population basis in primary care settings with co-payments based on income”.
The highly controversial proposals are set out in the report of a group of Department of Health officials which, over the past five years, has been reviewing various eligibility entitlements in place for services.
The review was established by former minister for health Mary Harney in the wake of the controversy over the illegal charges imposed by health authorities for accommodation in long-stay facilities.
The document was drawn up prior to the general election which saw the appointment of Dr James Reilly as Minister with a mandate to move away from existing arrangements for healthcare provision towards the introduction of a new universal health insurance model.
However, some of the proposals included in the document, such as reviewing the existing provision of free medical and midwifery care for mothers and newborn infants, are virtually identical to some of those set out in draft internal HSE cost-cutting proposals drawn up in recent weeks.
In a statement, a spokesman for Dr Reilly said the eligibility report was a document prepared for the previous Government which reflected its view of where the health services were going.
“Since we have decided that we are going to entirely reform the health services we’re going to have to take a complete look again at the whole eligibility issue.
“The planned introduction of universal health insurance will necessitate a fresh look at such matters.”
Asked about the status or current value of the proposals set out in the eligibility report, the Department spokesman said it would have to look at them again.
“We’re not nearly at the point where we’d be able to make a decision either way.
“Our focus at the moment has been entirely on the establishment of the special delivery unit and getting the reform process of our health services under way. We recognise that eligibility is a key issue that needs to be addressed, but during the 100-day priority period for Minister Reilly, it has not been our focus.”
One of the key findings of the report is that clarity is needed on who is entitled to what services under legislation.
“There is no statutory provision in the 1970 (Health) Act making it clear that people’s eligibility for/entitlement to services is subject to resource constraints. Although the State can point to the provision in the 2004 Act requiring the HSE to deliver services within its budget, there have been cases over the years seeking to establish an individual’s legal entitlement to receive a particular service and/or seeking damages for a failure to provide certain services, and that core question of whether a person’s entitlement to health services is subject to resource availability has never been determined by the courts.”
The report recommends that while individuals should in future have no access to the courts in relation to eligibility for services, there would be a statutory complaints and appeals system, up to and including the Ombudsman.
On eligibility to primary care services, the report urges that the list of items reimbursed under the GMS should be put on a legislative basis “in order to add/remove products in future and/or apply conditions for certain products”.
The report says that the existing free medical and midwifery care for mothers and children up to the age of six weeks as well as the health examination and treatment service for pre-school children and those of primary school age should be reviewed “in the light of developments in healthcare over the years to evaluate their impact on health improvement/status”.
It also says there should be a review of rehabilitative care, palliative care and mental health services “which can be delivered across a range of settings in order to support appropriate access to, and any charges in respect of, these services”.
For hospitals, the report says there should be new charges in cases where there is clinical certification that acute care is no longer required. It also suggests that patients receiving services under the National Treatment Purchase Fund should have to pay the statutory hospital charges even when this takes place in a private hospital.