Brennan Report - Department of Health and Children

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