We have a “consultant led/controlled” service as opposed to a “consultant delivered” service. This combined with a public/private healthcare service in which the government has provided and continues to provide huge direct and indirect financial support to the private sector. I have highlighted how this happens in the previous blog. In addition to this support it is worth noting that the profile of those who buy health insurance is more likely to be the better educated (often through a highly subsidised third level system) and the wealthier than the average EG; almost 60% of those in the top 25% of income earners are insured compared with just 18% in the law’s 25%.
Studies have shown that what influences people most to buy insurance is not the higher standard of accommodation with hotel style facilities, rather it is the assurance that they can “queue jump” to access treatment. As mentioned previously, access to treatment is primarily influenced by the strength of one’s wallet and not the severity or urgency of the ailment. Also let’s not forget that the most urgent requirement for all governments is the need to be re-elected and politicians are acutely aware that voting turnout is often higher among the better educated and wealthier sections of our society: those most likely to have private insurance. A Republic of Equals we are not !
Let’s fast forward to 2008 and onwards. It is well documented that consultants per population ratio in Ireland is well below that of other developed countries. The workhorses of the healthcare system in Ireland are the non-consultant hospital doctors (NCHD) often given work by consultants which frees up consultants to pursue their more lucrative private activity carried out in the same public hospital. 2008 is an important year; when a new consultants’ contract was agreed as a “precondition” to the government taking on more consultants. This contract positioned Irish Consultants as the highest paid in Europe and that did not take into account all their private fee income.Such is the strength ogf their trade union!
The contract requires them to work 37 hours a week in the public system, but where a consultant is treating both public and private patients in the same hospital the monitoring of time spent with public patients or with more lucrative private patients can become pretty blurred, and who is going to challange them?
What can be done to provide a better and more equitable healthcare service to all the citizens of Ireland? The 64 dollar question! The two tier syatem has become so entrenched that it will be difficult to change. Successive Governments have dithered and avoided decisive action to such an extent that the inaction evolved into Government Policy. There is some hope on the horizon with the advent of purely private hospitals. ( As an aside, isn’t it interesting that some of these new hospitals/businesses are now advertising for customers! Why does a bussiness spend money advertising? Easy, More customers == More profits, simple) There has been some talk of the spare capacity in these private hospitals being used to reduce the disgraceful waiting times in public hospitals. If a decision to do this was made it would be another example of huge amounts of taxpayer money going to subsidise the private hospital system. In the likely event that it will happen I believe the Government should negotiate “very special payment terms”. Longer term these private hospitals should charge the real economic price of their service to those who use it, and the amount of private work done in public hospitals steadily reduced. Consultants doing private patient work should treat private patients in private hospitals. Those consultants who wish to have a contract with the public system can do so but while in a public hospital not be distracted by their private patients in the same hospital.
Development and improvements in the public system can be partly funded by removal over a few years of tax relief for private insurance premiums, and in the transition period by charging consultants the full economic cost of using public hospital facilities and equipment to treat their private patients.
Word of Caution. Comparative figures can be tricky. EG. Healthcare spending as a % of GDP can be skewed downwards in Ireland since our GDP figure can be inflatedby including a huge pertcentage of goods and services produced by USA multinationals who export not only the goods and services but most of the profit also. On the other side our % spend figure is inflated in comparison to other countres since we include in Healthcare spending, disability support & comminity care of the elderly whereas other OECD countries class these as “social spending”.