Expectant mothers face increasing restrictions on accessing private maternity services from next week as new rules that aim to eliminate fee-paying medicine in public hospitals come fully into effect.
From the beginning of January, about two-thirds of the 4,700 hospital consultants in the State will be permitted to treat only public patients in HSE-run or State-funded voluntary hospitals. These consultants have signed up to a new Sláintecare contract introduced by the Government in 2023.
The Department of Health has told health insurers that transitional arrangements that allowed specialist doctors in public hospitals, who signed the new Sláintecare contract, to wind down their private practices over a number of years will not be extended beyond the end of December.
The HSE confirmed the end of the transition period in a memo to its senior management on December 18th.
The Irish Hospital Consultants Association (IHCA) said while the new rules would apply to all medical specialities, they would particularly affect obstetrics.
IHCA chief executive Jim Daly said that, unlike other medical disciplines, there were no private maternity units in operation across the State where women could access such care.
Studies suggest that just under 25 per cent of women nationally opt for either private or semi-private maternity care, with this rising to about one-third in some units.
Consultants in obstetrics and other specialities who have not signed up to the public-only contract can continue to see private patients in State-run and State-funded facilities.
Mr Daly maintained that under the new contract, consultants working under the new Sláintecare contract would also be permitted to continue to see private patients in public facilities if local management agreed. He believed that management in some maternity hospitals would be agreeable to such a stance.
However, he said health insurers would from the beginning of January no longer pay for subscribers treated by a consultant in a public hospital who operates under the new contract.
VHI, the country’s largest health insurer, told The Irish Times that from January 1st, it would “not process claims for private activity in a public hospital where the consultant has completed their transition period under the public-only contract”.
However, the State-owned VHI said it would “continue to pay charges where a member chooses to waive their entitlement to public treatment and opts for private care with an admitting consultant who holds a contract type that permits private practice in a public hospital.”
Laya Healthcare said: “We have been informed by the Department of Health that the 31st December 2025 deadline for the end of private practice by public-only consultants in public hospitals will be enforced. We understand that there will be no extension to this deadline, and we are planning on that basis.”
Mr Daly said as all new consultants since 2023 were appointed under the Sláintecare contract and could only see public patients in State hospitals, private practice would be eliminated over time in these facilities.
The annual report of the National Maternity Hospital for last year states: “The new public-only consultant contract was introduced in March 2023, which will, unfortunately, lead within a few years to women not being able to choose private obstetric care for their pregnancy. This will increase the burden of work on the public system which will prove challenging at times.”
The Department of Health told health insurance companies that an extended transition period had been offered to consultants who switched in 2023 to the Sláintecare contract. It said this transition period included key milestones, which the contract stated were the responsibility of the consultant to meet, to ensure an orderly wind-down of their private work. It said these milestones set were that private practice should be reduced to 20 per cent by the end of 2023, to 10 per cent by the end of 2024 to 5 per cent by June 2025 and to cease completely by December 31st.
VHI said the Department of Health told insurers it expected claim payouts would decline in 2026 to reflect the new public-only policy.
According to the HSE, under the Health Act 1970, all patients admitted in public hospitals have statutory rights. The public or private status of the patient is determined by whether the patient decides to waive their entitlement to avail of public services or elect instead to be treated on a private basis.