Why are public patients dying unnecessarily in our hospitals after waiting so long for treatment that it becomes too late to save them while private patients receive immediate treatment?
We are told that this is caused by a lack of resources in a public service so run-down that privatisation is the only solution. Instead of attempting to improve the service, its run-down condition appears to be seen as an excuse to feed the greed of those who would profit from this misfortune.
Let us look at the factors which are creating the shortage. The present system motivates doctors to place patients in beds who could be more efficiently treated as out patients, many chronic patients could be treated in the community or in their own homes by dedicated specialists. Many private patients are in public beds. Others are there because of over diagnosis and over treatment which places an inordinate and costly emphasis on high tech treatment at the expense of bed side clinical consultation.
These problems can be solved by the provision of community and home facilities for those who are presently occupying beds in our hospitals, withdrawing incentives to doctors to place patients in beds who could be treated as out- patients.
Solutions can also be found in the experience of other countries that have been faced with similar problems. In a number of states in the USA where the problems described above are infinitely worse than here, although we are getting there fast, there is a system known as the Kaiser Promenante Scheme. This scheme could be described as a co-operative of medical practitioners, insurers, patients. In fact everyone involved in healthcare. Participants of that scheme are treated at a fraction of the cost.
It has been suggested by Dr Risteard Mulcahy[1] that Ms Harneys ambition to place 11 private hospitals on the grounds of our major hospitals be replaced by a system whereby non profit hospitals were built on the grounds of our major hospitals with both hospitals under joint management without expensive state of the art high tech private for-profit hospitals as originally proposed by Ms.Harney.
A report[2] commissioned by ICTU which included the vast majority of health workers at all levels said:
“The Government should abandon its plan to permit and encourage private hospitals to be constructed on the grounds of public hospitals. The VHI should continue to serve national rather than private or parochial interests. Whatever the future of the VHI, it should not become a for-profit company”
Dr Hickey who works in the Cuban Health service told the Pat Kenny Show on RTE that it was second to none in spite of the poverty in that country.
The government coalition partners in their progress report[3] on the joint programme claim:
“The development of a world-class public health service is a core objective for us. Based on the blueprint set out in the National Health Strategy, a combination of greater investment and a reform of the system will provide a high quality and accessible health service for all. It will ensure a major expansion in the level and quality of services throughout the country. And it will encourage the end of the two tier health system by ensuring that public patients will have access to timely and quality services in all parts of the system”
It is difficult to square the assertions by the ICTU report, Dr Mulcahy and many others with the claims by the present government. The aspirations in the Government statement contrasts starkly with public patients dying because they were not attended to in time. Dr Mulcahy’s warning that our health service could end up as a one tier private system supported by private insurance is ominously borne out in the PD/FF progress report which promises to introduce a a one tier system[4]
The real revolution in our health service can only be achieved by the electorate in May by changing the present government. Given the failure of the opposition parties to support such radicalism when they were in power, one wonders if the alternative can be any better. It is for this reason that the election needs candidates who will support the alternatives outlined above..
[1] Mulcahy, R. (2006), Is the Health Service for Healing?,Liberties Press, Dublin
[2] Wren, M. & Tussing, A. Dale, (2006), How Ireland Cares, New Island, Dublin
[4] ibid (p 123)
