Brennan Report - Department of Health and Children

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Report of the Commission on Financial Management and Control Systems in the Health ServiceTable 5.1: Cost per Inpatient Bed Day Compared with Private Patient Charges,2000 and 2001Cost PerPrivateInpatient Patient SubsidyBed dayCharge¤ ¤ ¤2000:Group 1 Hospitals 5 465 232 233Group 2 Hospitals 6 347 192 1552001:Group 1 Hospitals 546 239 307Group 2 Hospitals 409 197 212Source: Department of Health and ChildrenFigure 5.1: Cost per Inpatient Bed Day in Group 1 & Group 2 Hospitals splitbetween Subsidy and Private Patient Charge, 2000 and 2001Cost per In-patient Bedday £600500SubsidyPrivate Patient Charge4003002001000Group 1Hospitals2000Group 1Hospitals2001Group 2Hospitals2000Group 2Hospitals20015Group 1 hospitals are the major academic training hospitals (i.e. Beaumont Hospital, Cork University Hospital, James ConnollyMemorial Hospital, Mater Hospital, St. James' Hospital, St.Vincents’ Hospital and University College Hospital Galway6Group 2 hospitals are non-teaching hospitals (i.e. all hospitals other than those categorised as Group 1).72
Chapter 5 Accountability – Hospital and Non-Hospital ProgrammesThe table above illustrates that for the larger (Group 1) hospitals, the economic cost per bedday increased by ¤ 81 from 2001 to 2002 (from ¤ 465 to ¤ 546). However, the private patientcharge for that bed day increased by just ¤ 7.As a result, the inpatient bed-day subsidy increasedby ¤ 74 in just one year (from ¤ 233 to ¤ 307).The table shows that there is a similar outcomein the smaller (Group 2) hospitals with the nominal subsidy increasing by ¤ 57 year on year.Thisoutcome for 2000/2001 is inconsistent with Government policy. 7TransparencyWe believe that the taxpayer is entitled to know how much of his/her contribution to taxrevenues is being spent on private patients in public hospitals. The full costs of treating privatepatients in public hospitals should be both transparent and publicly available. This reflects ourcore principle on patient costing i.e. that all costs incurred should be capable of beingallocated to individual patients.The benefit of making this information publicly available is that it would inform the policy debateand allow consideration of the real costs and State subsidies associated with the public/privatemix. A further argument for making any subsidy explicit is that significant hidden subsidies ofthe treatment of private patients in public hospitals may inhibit the development of privatefacilities that may be competing with private medicine carried out in public hospitals.Recommendations on Public/Private Mix in Public HospitalsR5.20 All Service Plans, Practice Plans and monthly, quarterly and annual reports should include a clear breakdownbetween public and private costs and activities.R5.21 A coding system should be put in place in all cases (e.g. outpatient activity, private patients having tests in apublic hospital etc.) and in all hospitals to explicitly identify all activity as relating to public or private patients, asappropriate.R5.22 The coding system referred to at R5.21 above should allow for allocating of general overheads incurred byhospitals between public and private patients so that the full cost of treating public and private patients can becalculated. The objective should be to identify the costs of treating individual patients.R5.23 The Executive should publish in its Annual Report a comprehensive analysis of the amount of public resources 8consumed by private patients within the public hospital sector.R5.24 Recognising that implementation of the information systems recommended in Chapter 10 will be necessary toproduce accurate information in respect of R5.23 above and the lead in time for the establishment of theExecutive, the Department of Health and Children should, on an interim basis, publish such information using thebest estimates that are available to it.R5.25 The provisions of Consultants’ existing common contract should be enforced to ensure that the following isundertaken:(i) The setting of core times when a Consultant must be available to patients in the public hospital; and(ii) Formal active monitoring of work commitment in respect of public patients.R5.26 The health board/hospital CEO should put mechanisms in place to ensure;(i) Consultants’ sessional contractual commitments to the public hospital are met; and(ii) The cap on private activity in public hospitals is observed both with respect to inpatients and day-cases(i.e. agree with Consultants on the number of private patients to be treated in public hospitals).7One of the recommendations of the “White Paper on Private Health Insurance” (1999) was that the gap between the charges forprivate patients and actual costs should be eliminated over a 5 to 7 year period.8At a minimum this should include direct public expenditure within the health sector.The Department of Health and Children shouldconsider the extent to which other costs, such as tax relief and medical teaching costs, should also apply.73
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Commission onFinancial Managementan
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TABLE OF CONTENTSEXECUTIVE SUMMARY
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6.4 COMMUNITY DRUG SCHEMES 80Medica
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Executive SummaryEXECUTIVE SUMMARYT
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Executive SummaryWe do not underest
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Executive Summary"demand-led" schem
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Terms of ReferenceTERMS OF REFERENC
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GlossaryEstimates for Public Servic
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Chapter 1 Introduction and Backgrou
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Chapter 1 Introduction and Backgrou
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Chapter 2 Overview and Issues2.2 OR
Page 23 and 24: Chapter 2 Overview and IssuesAppend
Page 25 and 26: Chapter 2 Overview and IssuesFigure
Page 27 and 28: Chapter 2 Overview and Issuesother
Page 29 and 30: Chapter 2 Overview and IssuesTable
Page 31 and 32: Chapter 2 Overview and IssuesFigure
Page 33 and 34: Chapter 2 Overview and Issues●●
Page 35 and 36: Chapter 2 Overview and IssuesIn 200
Page 37 and 38: Chapter 2 Overview and IssuesThe an
Page 39 and 40: Chapter 2 Overview and IssuesTable
Page 41 and 42: Chapter 2 Overview and IssuesProble
Page 43 and 44: Chapter 3 Managing the Health Servi
Page 59 and 60: Chapter 4 Service Planning, Budgeti
Page 65 and 66: Chapter 5 Accountability - Hospital
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Page 79 and 80: Chapter 6 Accountability - General
Page 89 and 90: Chapter 7 Accountability - Employme
Page 101 and 102: Chapter 8 Audit ReformCHAPTER 8AUDI
Page 103 and 104: Chapter 8 Audit ReformRecommendatio
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Page 107 and 108: Chapter 8 Audit Reformaudit reports
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Page 111 and 112: Chapter 8 Audit Reform●●Penalti
Page 113 and 114: Chapter 9 External Reporting Proced
Page 119 and 120: Chapter 10 Information SystemsStrat
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Chapter 11 Implementationbeing brou
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Appendix 1Appendix 1COMMISSION MEMB
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Appendix 1He has held this position
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Appendix 2SIPTU*South Eastern Healt
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Appendix 3Name of AgencyBord na Rad
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Appendix 3Name of AgencyIrish Blood
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Appendix 3Name of AgencyWomen’s H
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Appendix 4Department of Health and
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Appendix 4collated and assessed by
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Appendix 4The most detailed element
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Appendix 4Ratifying and Submitting
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Appendix 4changes to the Service Pl
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Appendix 4advised of their existenc
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Appendix 4Approvals Required in lin
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Appendix 5Appendix 5DIAGNOSIS RELAT
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Appendix 5Figure: Ax.1 Casemix Adju
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Appendix 6Appendix 6AUDIT OF STRUCT
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Appendix 7(vii)(viii)(ix)participat
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Appendix 8Appendix 8 - Integrated M
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ADDENDUMNumber Recommendation IT Ti
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Number Recommendation IT TimeframeR
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Brennan Report - Department of Health and Children

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