Higher-earning patients in Jersey could have to pay for part of their off-island care as part of proposals to change what costs are covered by the government.
Reforms include means-testing for patients travelling to the UK for non-emergency treatment, and in Jersey, charging all patients who stay in hospital when medically fit to leave and having been offered a care package.
The Health Minister, Deputy Tom Binet, says: “Somebody has to pay for all these treatments, and we have ignored that fact, in my view, for far too long.
“The whole idea is to have enough money in to shorten the waiting lists, to have a better, more reliable service.
“I think we need a more graduated system, with obviously wealthier people paying the most.”
It comes as Deputy Tom Binet has presented a draft report to the Health and Care Board, which could change policies such as the publicly funded healthcare eligibility, off-island travel and accommodation policies, and the rules on discharge-ready patients remaining in hospital.
The Board will review and provide comments on the items to further inform the Minister for Health and Social Services in determining any amendments and how best to implement them.
The draft reintroduces the pre-2017 policy of eligibility testing based on household income.
In the report, the Health Minister explains: “Healthcare costs are rising, and Health Care Jersey (HCJ) must ensure that finite public funding is used fairly and directed to the Islanders who need care.”
Also, outlined within the proposals are the potential risks that follow the reforms:
“Higher-earning patients referred off-island would have to self-fund parts of their travel or accommodation, potentially causing them financial pressure (mitigated through income thresholds linked to household earnings and household composition).”
“Ineligible visitors, who are not subject to a reciprocal health agreement, or new residents, may choose not to receive chargeable care (mitigated through communication that travel insurance should be taken out before visiting/moving to Jersey).”
“Patients who are medically fit for discharge and offered a care package but still choose not to leave the hospital, with the potential to incur bad debt.”
“Change in administrative processes for operational teams, and potential for increased questions or complaints during early implementation (mitigated through proactive internal and external communications).”
Deputy Binet warns of the consequences without the reforms, he says: “Off-island travel and accommodation costs will continue to exceed budget (due to rise in costs and rise in UK referrals), requiring other healthcare services to be cut.
“Delays that arise when discharge-ready patients choose to remain in the hospital will continue to reduce bed capacity, resulting in non-admission of other patients awaiting treatment and extending waits for elective care.”
How much could islanders be paying?
For non-emergency treatment, there would be four different levels of support:
Group A:
If you are a single adult and earn up to £48,100, and £112,800 if a family, you can get funding for accommodation, travel to the UK and travel within the UK.Group B:
Any adult earning up to £58,700 or £138,400 for a family would be eligible for accommodation travel to the UK.
Group C:Households earning up to £210,400 would receive payment towards accommodation only.
Group D:
Any household earning more than £210,400 would receive no support towards any travel or accommodation.
Publicly funded healthcare eligibility policy:
Currently, emergency care is free to access for all residents and visitors to Jersey, with access to free non-emergency care based on length of residency and economic contribution to the island.
The reforms would see visitors pay for all emergency care unless they have made a significant social or economic contribution to the island or are from the UK or another jurisdiction with a Reciprocal Healthcare Agreement, which allows citizens from one country to access necessary, often free or reduced-cost, state-provided medical treatment while visiting another country.
Residents who have moved to Jersey but are not working will be required to pay for emergency care until they have completed 12 consecutive months of residency.
Working residents who do not hold a “Licensed” status or a “Temporary Work Permit” must pay for emergency care until they have been working on the island for at least 6 months.
Discharge-ready patients remaining in hospital:
The draft also proposes that patients will be charged if they are medically fit and choose to continue receiving care in a hospital after a care package outside the hospital has been arranged.
The charges are:
£965 a day for the daily cost of occupying a private patient bed for long-term care services.
£450 a day for occupying an acute bed on a shared ward for long-term care services or part thereof.
£650 a day for using a private room for long-term care services on a shared ward or part thereof.
The purpose of the charge would be to improve bed capacity and to treat more patients.
Off-island travel and accommodation policy:
If approved, 30% of public patients would not receive fully funded overseas travel and accommodation.
Higher-income households would need to pay for part or all of their travel or accommodation.
Treatment would remain fully funded for eligible public patients.
The report adds: “This policy does not create new charges; it restricts access to a discretionary benefit for a limited group of patients from higher-income households.”
Deputy Tom Binet says: “The whole idea is to have enough money in to shorten the waiting lists, to have a better, more reliable service.” Credit: ITV Channel
Defending the proposals, the Health Minister Deputy Tom Binet argues: “This is a difficult one, a lot of people have paid into a tax system their whole lives, that is great, but I think we should have looked at health funding a lot earlier, because you cannot carry on getting more and more health services on the same budget.
“This is just the beginning of a process, looking at the very difficult business.
“There are lots of ailments that are deeply unpleasant, cancer being one of them. This isn’t really about differentiating by type of illness, it is probably about differentiating income, and I think at somepoint in time we may have to consider introducing some sort of graduated payment scheme.
He adds, there is no definite amount this system would save the health department, he explains: “It won’t be a fortune, I haven’t got the figure off the top of my head, and it won’t be a great deal, so this is the start of the process and it has to run a lot wider than just introducing small individual charges.
“This is just about taking these changes to the health advisory board to gauge their opinions on it.”
Answering how different illnesses will be categorised, Deputy Binet explains: “I am sure when we come up with this, we are going to have some exceptions for various circumstances, and if it’s graduated, that shouldn’t be too much of a problem.
“The whole idea is to have enough money in to shorten the waiting lists, to have a better, more reliable service.
“I think we need a more graduated system, with obviously wealthier people paying the most.”
In a statement, Health and Social Care says: “Under the draft proposals, all patients under 18 would be exempt. For individuals who travel frequently, there would be an option to apply for support on a discretionary basis.
“Please note that cancer patients were included in the previous 2017 means‑tested scheme, which did not provide any condition‑specific exemptions. Under the updated approach, eligibility thresholds would be determined solely by annual income as assessed by Revenue Jersey, with no consideration of assets.”
Commenting on the reforms, Vice Chair of the Health and Social Security Panel, Deputy Jonathan Renouf, says: “I think there are some serious questions to ask about the criteria for charging people.
“It says it will be when there has been a suitable care package identified, and if you don’t take the care package, you have to leave the hospital or pay.
“But who determines what a suitable care package is?”
Former patient, Sean Le Scelleur, says the reforms are “heartless.” Credit: ITV Channel
Former patient, Sean Le Scelleur, had a heart attack in April and had to spend 30 days in the intensive care unit in Jersey before being sent to the Oxford John Radcliffe Hospital, where he spent a further four weeks.
He explains: “I had a quadruple heart bypass, together with other ongoing issues. During this, I had my wife and daughter come over at separate times.
“The total costs associated with flying them over and keeping them in hotels, food and accomodation was over £6,000. None of which was refunded; there was no offer from the States of Jersey at all.
“It is frustrating and unsettling for those individuals who are going through the treatment process at the moment, because the goal post keeps continually changing.
He adds: “It is another goal post and I don’t think people, certainly not myself, would have ever budgeted for this.
“It’s heartless.”
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