The Republic does not have enough hospital beds to meet healthcare demand and there is an issue concerning fairness of access to the health system, a leading health administrator has said.
Dr Ruth Barrington, chief executive of the Health Research Board (HRB), who is stepping down from her post this month, also called for the creation of a common waiting list for both public and private patients. And she suggested that the decision to introduce a co-location model for hospital development, in the absence of a green paper or a white paper on the subject, was done "without thinking it through and getting a discussion going".
On the issue of inequality and fairness of access she said: "If you have an inadequate number of consultants and hospital beds, you are going to have people who . . . when they are ill and if they can get greater access by having private health insurance, they will take out health insurance.
"I think we have got ourselves into a bit of a mess in relation to fairness of access."
Pointing out that the Republic has the lowest ratio of specialists per head of population of any OECD country, she said that getting access to a consultant in the health system "is very difficult".
As well as needing good quality health professionals we require an infrastructure for them to work in and "it certainly looks as if we don't have enough beds to meet demand", she said.
On a common waiting list for hospital services, she said: "I think a common waiting list is crucial and the reason why it hasn't been introduced is because, politically, it would anger people with private health insurance."
The HRB chief said the gradual introduction of universal health insurance for the whole population would be expensive but "it could restore equity of access and hopefully equity of outcome for patients".
Asked about the co-location model as a way of adding capacity, she said that, in her opinion, the decision that these beds should be for private patients was made too quickly.
"My view is that these beds should be for elective work because that's what needs to be protected in an acute general teaching hospital. You would protect the non-acute work but you would also have a public hospital for the emergency and really difficult cases. And then if you had a common waiting list you could manage this [system] fairly."
The elective facility would be run by the public system and built by a public private partnership, Dr Barrington said.
Reflecting on the role of health research she said: "The HRB sees the health service as a holy trinity of education, service and research. If you can get the balance right between the three, that is the core of a really top class health service."
She said the HRB was concerned that discussions to date on a new consultants contract had not recognised the research role of clinicians. "Whatever contract comes in should have a flexibility to include research. We don't see that at the moment and this is a concern."
Meanwhile, in the 47th Annual Graves lecture at the Royal College of Physicians in Ireland tomorrow, Prof Tom O Dowd of the Department of Public Health and Primary Care at Trinity College Dublin will call for an extended role for the private sector in healthcare research.