As of 1 January, the vast majority of consultants on public only contracts will no longer be able to treat private patients in public hospitals.
This will affect consultants across all specialities, but will have a particular impact on access to private maternity services into the future as there are no private maternity hospitals.
"We find that one in four women choose to access private care and not public care," said Master of the Coombe Maternity Hospital in Dublin, Professor Michael O'Connell.
"Going down the line, that choice will be taken away," Professor O'Connell added, though he assured patients that little would change on 1 January.
This is because there are currently two different type of consultant's contracts.
There are contracts issued before March 2023, which allow consultants to practice privately in public hospitals.
Then there is the 'public only consultant contract' (POCC) introduced in March 2023.
Consultants who switched from the old contract to the 'public only' one in 2023 were given until 31 December this year to make the transition away from treating any private patients in public hospitals.
For consultants who signed 'public only' contracts after 1 January last year, the transition period was shortened to six months.
This effectively means that from 1 January 2026, the vast majority of consultants on 'public-only' work will not be allowed to treat private patients in public hospitals.
So what impact will this have on obstetrics, where private maternity care by consultants is only offered in public maternity hospitals?
"There won't be any great change initially," Professor O'Connell said.
Watch: Professor Michael O'Connell talks about the new rules for 'public only' contracts
This is because the consultant obstetricians who predominantly offered private maternity care in the Coombe Maternity Hospital are on pre-2023 contracts that continue to permit private practice in public hospitals.
"It's just down the line, over time, as those on the older contracts retire, they'll be replaced with the 'public only' contract," Professor O'Connell said.
He said that a woman's ability to choose private in-patient care in public hospitals will ultimately be taken away as this happens.
Maternity care specialist and advocate Krysia Lynch has said that pregnant women do need choices and may be fearful of this choice being taken away, but she also believes that work needs to be done in ensuring that there is access to and information about other maternity options.
"This was a choice, it was a very popular choice among people who have private health insurance and one of the reasons people made this choice was that they wanted to get continuity of care, they wanted to see the same person all the way through their care," Ms Lynch said.
She added: "However you could also argue that it wasn't really a choice because it was only available to people who could afford it and pay for it.
"Ireland has very few maternity choices, we don't for example have birthing centres, we have very few birthing pools, we don't have early transfer home in the postnatal period, where people are taken care of in their own homes, as standard."
Ms Lynch has also said that there is a lack of information available to women about some of the services available within the public health system, such as VBAC (vaginal birth after caesarean section) clinics and DOMINO Schemes provided by community midwives.
"We have been led as a society to believe that this is our only choice and actually it isn't and it shouldn't be," Ms Lynch added.
According to the Department of Health two-thirds (67%) of all consultants are now on 'public only contracts', but there was no breakdown available for how many consultant obstetricians are on these contracts.
A spokesperson for the Department said that the public only consultant contract was "a key step in delivering universal healthcare, ensuring public hospitals are used for public patients and care is based on medical need, not ability to pay".
State-owned insurance company VHI has confirmed that from 1 January 2026 it "will not process claims for private activity in a public hospital where the consultant has completed their transition period" under the public only consultant contract.
A spokesperson also confirmed that "Vhi's understanding, based on recent correspondence and guidance from the Department of Health to all insurance companies, is that there will be no extensions/exceptions to the transition period for POCC (public only contracted) consultants to cease their treatment of private patients in public hospitals regardless of their speciality or location".
A spokesperson for Laya Healthcare also confirmed that it had 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," the spokesperson added.
Both insurers also confirmed that they would continue to pay claims for members who avail of private treatment in a public hospital where the consultant has a pre-2023 contract that permits private practice in a public hospital setting.
Professor O'Connell said that these changes may also impact hospital funding.
"Eight percent to 10% of our budget comes from private bed income... that will have implications down the line," he said.
