A leading figure in the health service said "legitimate questions" could be asked about the value received from additional spending on health during the last five years.
Mr Pat McLoughlin, chief executive of the South Eastern Health Board, was speaking in Kilkenny yesterday at the annual conference of the Association of Health Boards.
He said when the issue is discussed nationally, critics point to the fact that our per capita spending on health has moved above the EU average, an increase of 134 per cent since 1997. He also said patients still face long waiting times to access services, with some having to wait on trolleys for admission to acute hospitals.
The health board chief stressed, however, that two-thirds of the increased funding for health went on pay awards, inflation and the cost of the community drugs scheme. Waiting lists for inpatient elective services were down by 19 per cent, with 20 per cent more consultants now employed.
Using the 202-bed St Luke's Hospital in Kilkenny as an example, Mr McLoughlin said the number of admissions at the general hospital had increased by over 3,000, while the number of out-patients seen each year had risen by 5,500. The number of A&E attendances had risen by almost 2,500, and the number of day cases by 2,500.
"Behind those statistics are some real improvements which have transformed the quality of care for patients. These have mainly stemmed from improvements in technology, manpower and the availability of basic facilities.
"The reality is that six years ago, patients were being admitted to a hospital which did not have enough beds, appropriate diagnostic services, or enough consultants with the range of skills to deal with patient needs."
Turning to the problems which still exist in the health service, Mr McLoughlin said he believed they must be looked at in the context of severe cutbacks in the 1980s.
"Between 1980 and 2000, the number of acute beds nationally was cut by one-third (the equivalent of 6,000 beds or a facility 10 times the size of Dublin's Mater Hospital), leaving the healthcare system to cope with one of the lowest bed-to-population ratios in the EU.
"Hospitals responded through reductions in the length of stay and, in particular, by adopting modern techniques and procedures. In Ireland we now carry out 36 times as many day procedures as we did in 1980."
Mr McLoughlin said he believed the public expects to have services similar to those in other highly-developed countries, but cautioned that, because of the historical situation regarding bed capacity and expenditure, it is not possible to achieve this quickly without investment in bed capacity.
"It is unrealistic to expect that waiting lists and waiting times will be improved significantly in the short-term without a sustained increased in capacity."
The conference also heard of the urgent need for additional services to allow older people stay in their homes where possible.
Mr McLoughlin concluded: "Despite the traumatic times in health in the 1980s, I believe the system has delivered good value-for-money compared to other countries. The goal of a world-class health service is achievable if we are prepared to invest more in services and reform structures towards that aim. Health reform could be part of a much greater reform of our public service."