Does our health service need to be reformed? Yes, definitely, according to Prof Risteárd Mulcahy, retired cardiologist and author of a new book campaigning for change, which was launched last night. Sylvia Thompsonreports.
Retired cardiologist Prof Risteárd Mulcahy has been a long-time advocate for reform of the Irish health service. In his new book, Is the Health Service for Healing? - A Doctor's Defence of Medicine's Samaritan Role (Liberties Press), he sharply criticises the development of private for-profit hospitals in Ireland and suggests that a one-tier compulsory health insurance system would offer everyone a better health service.
Launching right into the heart of the debate, he says, "no Irish government has ever issued a White Paper on what health system is best for this country. We need an all-party committee to decide what would be the best type of health service for Ireland.
"This Government has had knee jerk reactions in response to immediate and recurring problems and the Minister for Health, Mary Harney, makes decisions without consultation with all the stakeholders, including the patients."
Drawing examples from healthcare systems in Finland, Israel, Switzerland and North America, Mulcahy suggests that a one-tier health insurance system funded by higher income taxes is a fairer system.
"The [North American] Kaiser Permanente Healthcare Plan is a non-profit system which has efficiency in planning and administration and a medical profession with disincentives to admit patients to hospital and to avoid over-treatment and excessive use of tests," he writes.
In fact, as far back as 1974, when Mulcahy chaired the Irish Medical Association, it recommended the adoption of a one-tier nationwide hospital compulsory health insurance system.
Mulcahy is adamant that there is an inherent conflict of interest when doctors become investors in private for-profit hospitals.
He also firmly believes that private hospitals should be run only on a not-for-profit basis and suggests that his old "alma mater" St Vincent's Hospital, Dublin is a good working model in which a public teaching hospital and private hospital can co-exist.
He says he is amazed that so few doctors have become involved in a public debate about Minister for Health Mary Harney's proposals to build private for-profit hospitals in the grounds of many public hospitals throughout Ireland.
"The only input has been on the conditions of employment of the medical profession. We need much closer contact between the academic and vocational sides of medicine and the Department of Health," he says.
Mulcahy also firmly believes the development of private for-profit hospitals will result in "the overuse of expensive and sometimes unnecessary interventions and over-treatment of patients".
"There is no strong relationship between money spent on interventionist medicine, the general health of the population and life expectancy," he says.
He also contends that private for-profit hospitals will not be subjected to the same level of audit or peer-review as teaching hospitals. Throughout the book, he refers to Maev-Ann Wren's Unhealthy State:Anatomy of a Sick Society (New Island Books) and How Ireland Cares; The Case for Health Reform by Tussing and Wren (New Island Books).
Looking at the changes in medicine since he retired from hospital practice 18 years ago, Mulcahy says he believes that nowadays there is an over-emphasis on diagnostic testing and not enough emphasis on clinical medicine, including the taking of family histories and general contact with the patient.
"There is also a lot of unnecessary, imprecise and inappropriate use of drugs which is doing both financial and medical harm," he says.
Mulcahy believes it is to the detriment of both medical students and nursing students that they have less time to do hospital work in the early years of their study.
He is also critical of the high numbers of private patients occupying beds in public hospitals and the subsequent long waiting lists for public patients who are then taken off these waiting lists to be treated as private patients through the National Treatment Purchase Fund. "This is simply bizarre practice ," he says.
On bed management in general, he agrees with the chief executive of the Health Service Executive, Prof Brendan Drumm, who claims more hospital beds aren't necessarily the answer.
"We may need more beds in terms of population growth but we should first provide proper community services for older people or those who are chronically ill," says Mulcahy.
"This would relieve acute hospitals of an enormous amount of beds. Also, we should remove the incentives for doctors to admit patients to hospital for elective surgery. It is now widely recognised that many surgical procedures can be done in day care or as outpatients."
Mulcahy believes the medical and nursing professions should be central to the administration of hospitals. "They are being pushed out by a burgeoning bureaucracy. It's partly their own fault but there needs to be head of medical staff in the way that there are Masters in the maternity hospitals," he says.
On his own area of expertise, Mulcahy says the reduction in deaths from heart disease has been an tremendous success story. "You must consider that deaths from coronary disease have reduced by 75 per cent from the 1960s to 2000."
A physically fit and mentally alert 84-year-old, Mulcahy firmly believes we must take personal responsibility for our own health. An avid cyclist and walker, he also plays golf twice a week. He writes, "the seeds of chronic illness, of repeated hospitalisation, and of loss of independence in older people are most frequently sown in middle age when unhealthy lifestyles lead to the emergence of self-induced disease".
He continues, "to achieve a healthier society, education is more important than the provision of optimum elective health services. We should be vigorously attacking current social problems including alcoholism, poor nutrition, violence, the destruction of the environment, lack of physical exercise and diminishing social cohension," he says.
In his introduction to Is the Health Service for Healing?, Prof Niall O'Higgins, breast cancer surgeon and recently retired president of the Royal College of Surgeons, writes that the book is "a welcome and timely document".
Given that we are heading into a general election year, a wider debate on what type of health services we really want for Ireland seems appropriate. The question is who will join in such a debate and, more importantly, is the public ready to listen?