Ireland has the third most inequitable system in terms of access to hospital care, the Pfizer/ 'Irish Times'health forum is told, writes KATHRYN HAYES
OUR ACCESS to healthcare must be based on need and not on the ability to pay, a health forum has been told.
Healthcare in Ireland: Good If You Can Afford It? was the title of the latest in the series of Pfizer/Irish Times health debates.
Fintan O'Toole, assistant editor of The Irish Times, chaired the most recent event, which took place at Limerick Institute of Technology last week.
Referring to research carried out on healthcare systems in 21 OECD countries, Dr John Barton, cardiologist at Portiuncula Hospital, Ballinasloe, said Ireland was found to have the third most inequitable system in terms of access to hospital care.
The two most potent factors that contributed to that imbalance were private health insurance and medical cards, he explained.
Dr Barton said he believes the time has come to support the European model of healthcare, and he called for a change in the current funding structure in order to support such a system.
“If we believe in equity of access and treating people on the basis of need, we need to deliver a funding system that’s actually going to do that,” he said.
“At the moment our funding system absolutely solidly undermines solidarity and equity, and that is the reason why I would like to see change in our system of funding.”
The forum heard that at least 50 per cent of people in Ireland pay for private health insurance, many out of fear of the public system.
Prof Ciaran O’Neill, of the department of economics at NUI Galway, said he did not have private health insurance, but agreed there was a perception that having it afforded people speedier access to services.
“Different people have different reasons as to why they purchase private health insurance. I think there may be a perception that it does afford them more rapid access to care and it may afford them bigger choice in terms of where they can access that care,” he said.
Jan O’Sullivan, Labour’s spokeswoman on health, said this was a clear indication that the system had to change.
The Limerick TD said the most striking example of the unfairness of our system was the tragic case of the cancer victim Suzie Long.
The 41-year-old mother of two, who died in October 2007, claimed hospital delays condemned her to an early death.
Long did not have private health insurance and had to wait seven months for a colonoscopy to diagnose bowel cancer.
“If she had had private health insurance, she would have got it in days. She died because she didn’t get it in time,” Ms O’Sullivan said.
“So it is an indication that we absolutely have to change the system and we have to ensure that people get access on the basis of need and not on the ability to pay.”
When asked if they had private health insurance, an overwhelming majority of the audience indicated they had.
One man said his consultant told him he would have to wait 12 months for the treatment he required if he was a public patient.
“I couldn’t have accessed the service in the time I did without private health insurance, which to my mind is criminal,” he said
Access to healthcare and a choice of consultant are among the main reasons people purchase private health insurance, Donal Clancy, general manager of Quinn Healthcare, told the forum.
“It’s about having reassurance that if something happens, you are covered,” he said.
Ms O’Sullivan said the public already foots the bill for the majority of the cost of healthcare in Ireland, so people deserve a fairer system.
She said the cost of healthcare was €20 billion, 80 per cent of which comes from the public purse.
Mr Clancy said it was possible to reduce inequity in the health service without spending more money, if it was done in “a logical manner”.
He said part of this would involve comparing the length of times certain procedures take at different institutions.
Dr Barton said it was “intensely frustrating” working in the public system at present. “I’m working 20 years at it, and it isn’t easy at the moment. It’s quite difficult, and to see what’s happening is deeply frustrating, and there’s a lot of inefficiencies,” he said.
Dr Barton said the funding challenges facing the health system would not be resolved until there was increased integration between primary and hospital care.
“Until that happens, and until it happens in chronic care and chronic-disease care, we are not going to be saving much money. There is huge inefficiency in the organisation of the system aside from the funding of the system.”
He said that Portiuncula Hospital, where he has worked for the past 20 years, was required to save €7 million by the end of this year.
One of the suggestions put forward, he said, was to discontinue offering chemotherapy services in Ballinasloe, as this treatment was never included in the hospital’s budget, and to send patients back to Galway.
“This is the sort of stuff that is going on. It is demoralising, it is absolutely demoralising for people who are trying to provide a service, and to have that sort of thinking going on among management and financial people. It’s just so frustrating,” he said.
Jan O’Sullivan criticised the lack of accountability within the HSE and said she believed people on the front line should be allowed control hospital budgets.
She claimed the system had become “a straitjacket” of lack of information, where people are desperately focused on balancing their budgets instead of delivering patient care.
“It must be extraordinarily frustrating for people working on the front line, because they can’t control their budgets,” she said.
She said decisions affecting patient care were being made in back offices and not by clinicians on the front line.
Closing the discussion, Fintan O’Toole said it was striking to see the level of consensus that the current health system didn’t measure up in terms of equity or efficiency.
He said there was a broad acceptance that even within the current financial difficulties there were enough resources within society to produce a better system with better outcomes in terms of access to healthcare.
Acknowledging the current period of austerity, he said people were very proud of the fact that despite the appalling circumstances following the second World War, a decent healthcare system was produced.
“There is no reason why we can’t produce a decent healthcare system at the end of this period.”
