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 are private hospitals which do not receive state funding.
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 or regional or specialist hospital as required.
Everybody resident in 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 covers may cover some or all of the cost.
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 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.
Some persons must pay in-service charges.
There is an entitlement to a bed in a public ward, 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 a visitor or EU resident 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.
The charge for inpatient services is €75 per day to a maximum of €750 per year. The exemptions above apply. There charges may be waived in whole or in part in the cases of excessive hardship. There is a set rate for private beds. This in addition to inpatient charges.
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, anesthetists etc.
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 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.
There is a €100 charge for accident emergency and outpatient services where undertaken without GP referrals. It covers emergency departments, casualty, minor injury, urgent care centers 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,
- 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.
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 of the order of €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 as for public health services, for mental health services. Mental services inpatient and outpatient services are free of charge to persons under 16 years who suffer from a mental illness.
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 caed 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 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 in a hospital more than 30 days and the doctor certifies that medically acute care and treatment is 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 time 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.
Under the drugs repayment scheme ordinary residents are subject to a cap of €144 per month for prescribed drugs, medicines and appliances for use by a person and family. Generally, a dependant with a physical or a mental disability or illness may have a medical card. If they do not, they are included under the scheme.
It is necessary to register with the local health office. It is not necessary to register with a particular pharmacist, but maybe a practical necessity to avoid reclaim. A drug payment scheme cards lasts for five years. Renewed application are made. The application is made to the health office.
Medical cardholders pay €1.50 per prescription item. This is subject to a ceiling of €19.50 per month per family. This does not apply to certain persons.
- long-term illness scheme
- persons who receive drugs free of charge
- children with their own medical card
- methadone scheme payment
Approved prescribed drugs are available at community pharmacies. Most pharmacy shops have an agreement with the HSE and provide primary care services subject to reimbursement. Pharmacists have undertaken under the agreement to review treatment and screen for possible allergies, misuse and abuse.
Where there is no pharmacy within three miles of the GP, a GP may dispense medicines. Hospitals and other institutions may dispense directly.
Drugs are prescribed by doctors and certain nurse prescribers employed by the health services. Their right to prescribe may be limited to a particular category of drug relevant to their specialty.
Drugs and medicines are approved by the HSE under the scheme. This is in addition to the basic marketing and licensing approvals required for marketing the drugs by the Irish Medicines Board / Health Products Regulatory Authority. The schemes do not apply to certain over-the-counter medicines that are purchased and sold on a retail basis.
Certain persons suffering from long term conditions who are not medical cardholders may obtain drugs, medical and surgical appliances under the long term illness scheme. The qualifying conditions include mental handicap, mental illness under 16 years, diabetes, hemophilia, cerebral palsy, epilepsy, spina bifida, multiple sclerosis, cystic fibrosis, Parkinson’s disease, acute leukemia, certain thalidomide conditions.
Persons qualifying will receive a list of medicines for which they are entitled to, free of charge through the community pharmacist.
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