Private patients and public hospitals


Sir, – You report that Minister for Health Simon Harris will tell Cabinet that the elimination of private patients from public hospitals will free up 2,000 beds across the country and reduce waiting lists by 25 per cent (News, November 11th).

The Minister’s claims are naive and misleading. When private patients are eliminated from public hospitals the only change for emergency patients carrying health insurance who are admitted to a public hospital is that they will no longer pay for the treatment received.

The current income received by public hospitals for the treatment of private patients is approximately €650 million per annum, approximately 15 per cent of the national hospital budget.

When this funding is no longer provided by private patients, usually through insurers, it will have to be replaced from government funds in order to maintain patient care in public hospitals at the current level. So what are the benefits to be expected in the provision of healthcare to public patients for this significant investment?

Private patients seeking comprehensive emergency care will find this only in public hospitals. A private alternative does not exist as there is very limited provision of emergency care in private hospitals, service being usually restricted to between 8am and 6pm, Monday through Friday. The capability to treat major trauma has yet to be developed in private hospitals. Outside these hours and at any time for major trauma, private patients are always treated in public hospitals. As Irish citizens, we are all entitled to access public healthcare.

There is very little likelihood that full-time emergency departments will be developed in private hospitals as there are strong disincentives. Huge financial investment would be required to develop the capacity to deliver complex trauma care. Increased private bed numbers would be essential as would the agreement of private healthcare insurers as covering private patients in private hospitals is much more expensive than covering them in public hospitals.

When private patients plan a hospital admission with their doctor they usually opt to receive their care in a private hospital mainly for more immediate access and greater comfort.

The principal exception to this is mainly in rural areas where a public hospital may be conveniently located while the nearest private hospital is less attractive, possibly being more remote.

As there will be little or no change in the admission of emergency patients the impact of eliminating private patients from public hospitals will be limited to the consequences of the reduction in elective admissions. Since the elective admissions of private patients to public hospitals is predominantly in rural areas, where the numbers treated are relatively small, it is likely that the number of extra beds available nationally will be small and at enormous cost.

However, this precise information is available from knowledge of the total number of private bed days in public hospitals attributable to patients admitted electively.

The HSE and the Department of Health can provide exact information that will reveal the number of extra bed days that can be realistically expected to be available to public patients.

It appears that we are embarked on spending €650 million to achieve a small increase in the availability of extra hospital beds for public patients. To put this in context, this level of funding is approximately the same as is predicted in the report to deliver in its entirety the rest of the much-needed reforms contained in the Sláintecare programme. Alternatively, €650 million would cover the cost of building the equivalent of the new children’s hospital at the most recent cost projections, every three years.

Donal de Buitléir was requested to chair a group to analyse the impact of “disengaging” private practice from public hospitals as set out in the Sláintecare report. This report has been widely accepted as having satisfactorily addressed its remit. However, Dr de Buitléir merely concludes that it is affordable. It does not address the impact on the provision of public healthcare in hospitals or the impact of funding this change. Dr de Buitléir assures us that this is affordable. However, it is obviously poor value for money.

Eliminating private patients from public hospitals will deliver on an ideological ideal but it will be associated with much less benefit than naively expected and at extravagant cost.

There are much better ways of using this funding to improve public healthcare such as doubling the budget to deliver the rest of the Sláintecare plan. The Minister for Health should address these issues.


Dún Laoghaire,

Co Dublin.