Hospital Services
Hospital Types
Hospital services. There are two broad categories of hospitals in Ireland in terms of ownership and control. There is minimal difference between the first two categories in modern times.
HSE hospitals are owned and fully funded by the Health Service Executive. Voluntary hospitals are funded by the HSE and state but are for historical reasons owned by private bodies. In most cases, the hospitals were founded in the 18th and 19th centuries by religious and charitable bodies. Some are incorporated by charter. Some are run by boards appointed in whole or in part by the Department of Health.
Another category of hospital is private hospitals, which do not receive state funding.
Services Provided
HSE hospital services are provided in HSE-owned hospitals and voluntary public hospitals. Both types of hospitals provide private healthcare with both public and private beds.
Some hospitals are general hospitals catering for a range of services. Others are specialist or acute hospitals dealing with particular types of illness and needs, including cancer hospitals, psychiatric hospitals and maternity hospitals.
The general and regional hospitals provide a range of services. Smaller local hospitals may provide more limited services. They will transfer patients to a general regional or specialist hospital as required.
Entitlement
Everybody who is a resident of the state and certain persons visiting are entitled to free maintenance and treatment in public beds in HSE and voluntary hospitals. Some persons must pay hospital charges. Outpatient services at a public hospital are free, but some people must pay an initial charge if they have not been referred by a GP.
Persons in private beds in public hospitals must pay for both maintenance and treatment. Private health insurance coverage may cover some or all of the cost.
Private patients of a consultant are obliged to pay for the consultant’s services. They are also obliged to pay for other services such as radiologists, anaesthetists, etc.
Generally, a GP referral is required for hospital services. There may be waiting lists for non-emergency services.
The entitlement to inpatient and outpatient services applies generally to residents.
Most general hospitals and some specialist hospitals have an accident and emergency department. Patients may attend without a GP referral. There is a €100 fee on the first visit. The €100 fee does not apply to
- medical card holders,
- persons admitted as a result of attending casualty.
- persons receiving treatment for certain infectious diseases
- children up to six weeks old
- children suffering from certain diseases and disabilities
- children referred for treatment from health clinics and school health examinations
- women receiving maternity services
- persons entitled to hospital services under EU legislation.
Bed in Public Ward
There is an entitlement to a bed in a public ward, Â free consultant services and outpatient services in a public hospital. Persons who seek private treatment in a private bed in a public or private hospital must pay for their maintenance and treatment.
Persons who are not ordinarily resident in Ireland are not entitled to free or subsidized services as visitors, or EU residents may be obliged to pay the full cost of the service.
In-patient services are institutional services provided in hospitals, convalescent homes and homes for persons with mental and physical disabilities. Day care may be an inpatient service.
There may be waiting times. Information for waiting times procedures is available online. See also section on the national patient treatment register.
Some persons must pay in-service charges. The charge for inpatient services is €75 per day to a maximum of €750 per year. The exemptions above apply. The charges may be waived in whole or in part in cases of excessive hardship. There is a set rate for private beds. This is in addition to inpatient charges.
2023 Changes
Hospital charges for public inpatient care or day service care were removed on 17 April 2023. Inpatient and day service charges still apply for inpatient and day service care up until and including 16 April 2023.
EU States
The entitlement to services in other EU states is dependent on domestic legislation. This legislation is largely determined by EU directives and regulations. Individuals resident in another EU state are usually entitled to medical benefits on the same basis as nationals of that state.
An individual from one state is entitled to medical benefits and the same benefits as nationals in the host state if authorized by the institutions of the home state. The authorization must be granted if the treatment is amongst the benefits provided in the home state and the individual cannot be given the treatment within the time necessary for obtaining it, due to taking account of the cause of disease and current state of health.
Authorisation may be given by the HSE for treatment in other states on a wider basis. The cost of treatment is covered by the state providing it but is reimbursed by the home state.
The application is made in advance of travel to the host state. Medical evidence must be provided by a consultant who must certify that the treatment is not available and is urgently necessary. There must be a reasonable medical prognosis, and the treatment abroad must be a proven form of medical treatment.
It must be undertaken in a recognised hospital or other institution under the control of a registered medical practitioner. The HSE may contribute to other costs outside the scope of EU legislation on a case-by-case basis.
Outpatient Services
There is a €100 charge for accident emergency and outpatient services where undertaken without GP referrals. It covers emergency departments, casualties, minor injuries, urgent care centres, and similar facilities. The following categories are exempt.
- Medical card holders, persons admitted as inpatients.
- Persons receiving treatment for prescribed infectious services,
- persons with certain diseases and disabilities,
- Â children under six weeks, referrals from child health clinics and school health examinations, women availing of maternity services,
- persons entitled to free hospital service under EU law.
The charge applies on the first visit. It does not recur on subsequent visits for the same matter.
Inpatient Services
A person detained overnight is receiving inpatient services. Otherwise, he is availing of day services. There is a charge for inpatient day services of €75 per day to a maximum of €750 in a 12 month period. The same exemptions as set out above apply.
The maintenance rates for persons in private beds and public hospitals are in addition to the inpatient charges above. The maintenance rates vary between regional and county hospitals and district hospitals. In respect of regional hospitals, there are minor differences between semi-private and private.
In the larger regional hospitals, the daily rate is €1,000, with €753 for daycare. In district hospitals, this falls to €260 for services and €193 for daycare. This is in addition to payments for consultants and attendant services.
There are the same entitlements for mental health services as for public health services. Mental services inpatient and outpatient services are free of charge to persons under 16 years who suffer from a mental illness.
Longer Stay
The HSE may apply hospital charges to those on long stay or extended care in addition to normal inpatient charges. Where a person is an inpatient for more than 30 days within a 12 month period, the charges will arise. They apply to all persons, including medical card holders.
The maximum charge for a public long-stay care patient is €175 per week. There are two classes of public long-stay care patients. Class 1 applies to those receiving inpatient services and nursing care as provided on a 24-hour basis. The maximum charge is the lesser of €175 or their weekly income less a sum between €33 and €37.
The second class of persons receive inpatient services where nursing care is not provided on a 24-hour basis. The maximum charge is the lesser of €133 or the person’s weekly income less a sum between €64 and €69.
Where a person is in a hospital for more than 30 days, and the doctor certifies that medically acute care and treatment are not required, he may be charged as receiving long-term residential care services.
The National Patient Treatment Register is an online database setting out waiting times for inpatient and day hospital procedures in public hospitals. A person eligible to be placed on the waiting list is entered on the register by a GP or a consultant referral.
2020-2023
The Health Act 1970 (as amended) provides that charges shall be made for acute in-patient services provided by or on behalf of the Health Service Executive. Formerly, public patients (including children) are subject to a daily rate of €80 for acute in-patient services up to a maximum of 10 nights (€800) in a 12-month period.
The purpose of Health (Miscellaneous Provisions) (No. 2) Act 2022Â was to amend the Health Act 1970 to provide for certain exemptions from charges for acute in-patient services, in particular, to provide an exemption from such charges for children less than 16 years of age in all public hospitals and for persons who have chosen to avail of private acute in-patient services (and who therefore are charged in accordance with the Fourth Schedule of the Act).
The Health Act 1970 (as amended) provides that charges shall be made for acute in-patient services provided by or on behalf of the Health Service Executive. Currently public patients are subject to a daily rate of €80 for acute in-patient services up to a maximum of 10 nights (€800) in a 12-month period.
The purpose of this Act is to amend the Health Act 1970 to remove the acute public in-patient charge of €80 per day, up to a maximum of €800 in a year, for people accessing care as a public patient in public hospitals. The Act also revokes the Health (Acute In-Patient Charges) Regulations 2021 (S.I. No. 213 of 2021).
The charges shall be made for acute hospital in-patient services provided by or on behalf of the Health Service Executive and (2) revokes the Health (Acute In-Patient Charges) Regulations 2021 (S.I. No. 213 of 2021).