The charge for people attending hospital casualty departments will rise from £12 to £20 tomorrow. The new fee, announced in the Budget, has been criticised by the Irish Patients' Association, which says it represents double taxation.
The fee is being increased partly to reduce the numbers of people attending hospital casualty departments for relatively minor complaints, rather than going to their local doctor.
If next year's attendance at accident and emergency departments remains at the same level as 1997, the fees income is expected to be about £2.85 million. Income from the £12 charge in 1997 was £1.7 million.
Mr Stephen McMahon of the Irish Patients' Association said the 67 per cent increase in the fee was not the most effective way of dealing with the problem.
"It is far more important to try and understand why people go to the A&E and not to the GP. Elderly people may fear the onset of a cold or parents may be concerned about a child's developing condition."
He also said that the increase may lead to general practitioners in rural areas, whose fees are less than in urban areas, increasing their charges.
"If it turns out that the visit is an appropriate one, will the patient then get a refund for what has turned out to be a timely attendance at the casualty department?" he asked.
In response to a Dail question by Mr Alan Shatter TD earlier this month the Minister for Health, Mr Cowen, said that the charge applied only to those attending A&E departments without referral from their general practitioner, and only for the first consultation.
Among those exempted from the charge are medical card holders and their dependants, pregnant women, children up to the age of six weeks, children suffering from certain diseases and children referred for treatment from child health clinics and school health examinations.
Each year over half a million new patients attend A&E departments in the State.
On Monday the eight health boards are to introduce their third campaign to inform the public on the appropriate use of these departments.
According to hospital statistics, new attendances in the Dublin area have risen by 37 per cent over nine years, reaching 1.19 million in 1996.
A £10 charge for outpatient services was introduced in 1987.
In March 1993 the charge was raised to £6 per visit and in March 1994 to £12.
Meanwhile, an editorial in the Irish Medical Journal said that casualty departments are no longer perceived just as the place to attend after an accident, but rather as a "walk in at any time" service, irrespective of the nature of the complaint.
The journal's editor, Dr John Murphy, said: "The A&E services in Ireland are the unplanned product of modern medicine and modern life. Much of the development and expansion has occurred with little order and structure to date."
He said that as most patients are self-referred, community services, including GPs, have little control.
"The services are far removed from the glamour and buzz that is depicted on television. Patients are dissatisfied with long waiting times and sometimes uncertain opinions and diagnoses of inexperienced medical staff."