Patient access: The Tánaiste and Minister for Health, Ms Harney, has indicated that she would like to see fewer private patients treated in public hospitals.
Ms Harney told the Dáil last week that she would "like to move to a situation where more of the private activity would be moved to a private environment so that public beds can be used for those in greatest need".
She said the mix of private and public patients in State-funded hospitals had generally worked very well from the perspective of private insurers. However, she said the issue was one of equity.
Under Department of Health regulations governing the traditional public/private mix in hospitals, around one-fifth of all beds are reserved for fee-paying patients.
However, Ms Harney indicated this limit was being broken and that higher numbers of private patients were being treated in public hospitals.
"I would love to see a situation emerge which would be neutral in terms of how public hospitals are paid for private and public patients, if one wants to use that language. Clearly there are great incentives when one type of bed earns more money than another type.
"We all know that the 80:20 ratio is not being maintained, which is unsatisfactory," the Tánaiste said.
Ms Harney's comments were the first indication that the Department of Health would like to see private patients being increasingly directed to private hospitals and clinics, leaving greater scope for public patients in State-funded hospitals.
Previously this concept had been proposed by the Department of Finance under the former minister, Mr McCreevy, as part of its lengthy row with the Department of Health over health funding.
Mr McCreevy granted generous tax breaks to the developers of private hospitals in recent years as part of this policy - a move which was strongly opposed by the Department of Health.
Public hospitals earn over €200 million annually from fees generated by private patients using their facilities.
These private earnings have traditionally been taken into account by the Department of Health when allocating Exchequer funding to hospitals and health boards.
Previously the argument of senior figures in the Department of Health has been that a reduction or elimination of private patients from public hospitals would involve the State having to provide hundreds of millions more in funding to make up the financial difference.
There has also been a policy by the Department of Health in recent years to encourage consultants to carry out their private practice "on-site" on the campus of the public hospitals rather than in private clinics or rooms elsewhere.
The reduction of private practice rights in public hospitals would almost certainly lead to industrial relations difficulties with the representative bodies for hospital consultants.
However, there has been strong criticism in the past of the absence of a common waiting list between public and private patients in State-run hospitals which, critics have claimed, meant that those patients who were the most ill were not always given priority.
