Republican News · Thursday 26 October 2000

[An Phoblacht]

Invest to overcome inequity

ESRI report shows half of private patient costs are being borne by taxpayer (strap)


26-County taxpayers are spending 130 million annually to subsidise the hospital stays of private patients. These were just some of the findings in a report published by the Economic and Social Research Institute (ESRI) on the 26-County private healthcare sector.

Much of the conclusions on Private Practice in Irish Public Hospitals would have come as no surprise to many Irish people, who have resigned themselves to finding the best way possible through the inequities, inadequate services and huge treatment waiting lists that characterise the Irish health care system.

The best way through these problems is by spending money and 43% of the people surveyed by the ESRI had bought some form of healthcare insurance.

77% of people surveyed said that the reason they had bought health insurance was as a means of ensuring they got ``good treatment in hospital''.

The survey also found that 83% of households at the highest income levels bought health insurance. More startling was the fact that 11% of those on the lowest income levels also bought health insurance showing that those on low incomes who can find money to pay for private healthcare will do it rather than depend on a clearly inadequate public system.

The ESRI report is important but is only half the story. The state subsidies of private health care is only one part of a grossly inequitable two tier system, that sees public patients on waiting lists, not just to get treatment, but even to get seen - while patients who have cash can get appointments and medical treatment within weeks.

Hospital Consultants in the 26 Counties have a basic public sector salary of between 69,000 and 83,000. This varies from health board to health board.

Areas and specialists with low private patient numbers get the higher rates. For this the consultants work 33 hours a week. They can also qualify for emergency allowances up to another 17,000 a year, which is a sum just over the national average wage in 1998.

However the salaries of consultants does not end here. They are also allowed to work unlimited private hours in public hospitals, using public medical resources and offices for their private business.

This means for many consultants an effective doubling of their salaries. The average VHI payment to consultants last year was 87,000. This does not count additional cash consultants receive from purely private patients.

The salaries of hospital consultants are just one aspect of a sick health service. It highlights though the systematic inequity throughout the health service in Ireland. Successive governments have allowed a system emerge where they have cut health spending, particularly in the 1980s when 20% of hospital beds were removed from the system and never replaced.

The net outcome of this was to place huge pressures on hospital staff, particularly nurses and junior doctors, who recently had to threaten industrial action because the Dublin Government said it would take 13 years to reduce their 70 hours plus working weeks.

These extreme working conditions have created a flight of Irish medical staff from the country, even though in most cases their education to become health professionals is heavily subsidised by the state. For example in the Midlands, Mid West, North East, North West and South East health boards, 79% of registrars are non-Irish nationals, while 66% of house officers fell into the same category.

The Irish Hospital Consultants Association say they want to increase the number of consultants in the system but there is a clear need for not just an increase, but a virtual doubling of the number of consultant doctors as well as huge increases in the amount of registrars, house officers and junior doctors in the health service.

This means the Dublin Government committing itself to spending money. Spending on health is the lowest in the EU in Ireland, despite the fact that our economic growth rates are putting us on a standard with the rest of the EU.

In 1960 health spending in the 26 counties was 89% of the EU average. By 1989 it had fallen to 54% of the EU average and by 1998 it has slowly increased back to 80% of the EU average.

However even these figures are deceiving because over half of the recent increases in health spending have gone on wages of staff. There is a serious need to spend significant sums on our health service. This is not just spending money. It is an investment in all our futures.

Issues like this are the acid test of the purpose of the `tiger' economy. If the economic growth and prosperity can not be used to tackle something as clearly inequitable and underfunded as the health service then what really is the point?

Fianna Fáil Health minister Micheál Martin made a name for himself, during his short tenure as Education minister, as someone who recognised the need for substantial investments to be made in educational resources. Will he now take up the challenge of our underfunded health service?

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