How can workers give of their best if they are worried about health care costs? How can a mother or father concentrate at work if their sick child has been put at the end of a long waiting list? How can workers on low incomes feel a genuine partnership with employers when employers and their families, being richer and having private health insurance, can gain access to timely, quality healthcare in our two-tier health system? The Irish health care system discriminates against the poor and low-paid. Blatant discrimination is evident in the queue-skipping by people with private health insurance.
It is present in the quality of care given in some GPs' surgeries to private patients compared to the lesser attention and care offered to medical card holders.
People earning as little as £9,000 (€11,427) a year do not qualify for a medical card. A recent conference on health inequalities in the health system, organised by Society of Saint Vincent de Paul, heard of a 55-year-old man, just outside medical card eligibility, who died from TB. Fear of medical costs brought about his "untimely and preventable death", Dr Muiris Houston, medical correspondent of The Irish Times, said. "On £9,000 a year, you do not qualify for a medical card," said Mr John Monaghan, chairman of the national social policy committee of the St Vincent de Paul. "We see low-income families with children suffering because they don't have a medical card."
Money and social class influences access to healthcare and the quality of the service received, he said. He cited instances of poorer people having to wait longer to gain access to hospitals or their being discharged more quickly after an operation than private patients. A four-year-old child had to wait a year for an appointment with an ear specialist. "While waiting, his preventable ear condition worsened to the point where he developed a speech impediment," Mr Monaghan said.
The ability to pay, rather than medical need, is the dominant characteristic of the Irish health system and this is fundamentally unjust. There is a "gross inequality of access to health care", he added.
Mr Noel Clear, national president of the St Vincent de Paul, said the society was "demanding improvement in the health care system which offers access, equity, quality and accountability to all citizens". Dr Richard Layte, of the Economic and Social Research Institute (ESRI), presented graphs showing that the number of deaths and prevalence of chronic illness rises sharply among the unskilled manual social class. He noted that the grades people get at school can be an indicator of future health. Dr Tony Holohan, specialist registrar in public health medicine at the Department of Health and Children, said there were "considerable inequalities" in the system. Clear links exist between poverty and ill health, and the inequalities in the health system need to be made a political issue, he added.
In 1990 the ESRI found significant mortality differences between different socio-economic groups, and the gradients may be even steeper than in Britain, which itself was found to have a more marked gradient than many other countries.
"That ESRI report also found that occupational hazards were a factor in the poorer health of certain sectors of society, as was the quality and access to health care.
"Illness results from poverty and results in poverty," said Dr Holohan, advocating the need to health proof policies (which could be applied as much within the workplace as in politics). Ms Anna Lee, chairwoman of the Combat Poverty Agency, said: "Poor people get sick more often and die younger than the well-off . . . The scale of income difference, the bigger the gap in inequality, the more life expectancy drops."
The conference established beyond doubt that there was a two-tier health system in Ireland, with the poor and low-paid discriminated against in the most blatant fashion.
jmarms@irish-times.ie
