As we saw recently by 2008 some 52% of the population had invested in private healthcare insurance systems. We know that since the recession this figure has dropped for economic reasons down to about 44%. For so many people to decide to buy private health insurance it surely indicates a high level of dissatisfaction with the public healthcare system. This dissatisfaction was confirmed in a Euro barometer survey in an OECD Health Data Report Ireland exhibited a higher level of dissatisfaction than almost all of the 34 countries surveyed. The countries which were happiest with their healthcare system were Finland France and Belgium where the level of positive responses was more than double the negative ones.
Unfortunately since 2008 we know our public health service has worsened. We clearly have a two tier health service; separate waiting lists for public and private patients. Decisions on when you can receive treatment is decided much more by the strength of your wallet rather than the severity of your medical condition! Does anyone honestly think this is a fair situation? I have no problem with people having private healthcare but I do believe the two systems, public and private, should have two distinct and separate funding streams. There are huge subsidies flowing from the public purse to the private healthcare system.
1) The government coffers lose millions annually through tax relief on private health insurance premiums. In reality the government is encouraging the growth of the private healthcare system.
2) Public hospitals do not charge the Insurance companies the real cost of providing accommodation to private patients; best estimates are that the charge is between 50% & 60%of the full economic cost.(Tussing & Wren 2006:139)
3) Public hospitals do not charge for the use of their equipment when treating private patients.
4) All the costs of professional training, hospital development and Accident & Emergency Service run 24/7 are borne by the public system.
The conclusion of the Commission on Financial M’gt & Control Systems in the Health Service 2003 was that “considerable subsidies flowed from the Taxpayer to private hospitals & private patients in public hospitals”. I can find no evidence to suggest that this has changed in any way.
In 2002 much political mileage was made out of the introduction of the National Treatment Purchase Fund (NTPF) which was to alleviate excessive waiting time of public patients for specific procedures. The theory looks fine but in reality, while some patients are treated outside the State), a significant number 44% in 2004 went as private patients in a public hospital and the majority were treated by the same consultant who referred them initially to the NTPF from his public patient lists! This almost sleight of hand has been severely frowned upon. But who the decision makers are in referring people to the NTPF and who will probably benefit financially, it is another way in which the Government is actively supporting private healthcare from the public purse.
This one is definitely the last example of how much “closer to Boston and away from Berlin” that we have moved since 2000. The Fianna Fail/Prog Democrat Government encouraged for-profit private hospitals to build on publically owned land adjoining public hospitals. Without taking the value of the land into account, “tax breaks” have been reckoned to be as high as 40% of the cost of these facilities! (Burke2009).
This peculiar mix of private & public in public hospitals is largely due to the structure of specialist care provision in hospitals. We have had a “consultant led” service, not a “consultant delivered” service.
Update on where we are will follow, too much in one sitting!