Consultants in Irish hospitals can earn an additional income of up to two to three times their public salary by doing private work, a conference on the health service held in Donegal at the weekend was told.
Mr Chris Lyons, general manager of Letterkenny General Hospital, said he had recently returned from working in the UK system, which was "much fairer". It was "a public scandal" that in the Republic private patients could jump the queue ahead of public patients.
Mr Lyons said the consultant's contract in the Republic was one of the most favourable in the Western world.
"It is the envy of consultants in England - they have very good pay and then they can go away and top it up two or three times with private work," he said.
The Colmcille Winter School, an annual event held in Gartan, earlier heard that consultants earn in the region of £90,000 annually for 33 hours per week of public work.
Mr Lyons was responding to a lecture given by Maev-Ann Wren of The Irish Times on the topic "The Health Service in Crisis - Agenda for Reform". Mr Lyons said he agreed reform was urgently needed and that, firstly, consultants should be told that they either work in the public system or the private system, but not both.
Mr Lyons said premiums for private healthcare were artificially low and that patients should be charged the full economic cost of private care. Tax relief on private health insurance was further reducing the real cost. He said private patients should no longer be allowed to "piggy back" on the public system.
Dr Mary Grennan, a GP in Co Louth, said it had reached a point where she could not get an appointment with a neurologist for a public patient. She could only get one by contacting a consultant personally and sending private patients to the same consultant as "a pay-off".
Ms Wren, the author of a series of articles in The Irish Times which provoked widespread debate on the state of the health service, said it was obvious the system was in crisis and that people were treated according to income, not need.
"We don't spend enough, we spend badly and we spend unfairly," she said.
Ms Wren said many routes had been proposed to ensure equity of access. It could be achieved by taking private practice out of public hospitals; having a common waiting list; putting every patient on the same footing by giving everybody private insurance; funding the entire system through compulsory social insurance; paying doctors in the same way for every patient they treated.
"We should take as a given that what we have is a disgrace and must be reformed," she said.
To ensure quality of care the hospital network around the State had to be reorganised so that each region had a top-class acute hospital.