The Minister for Health's plan for 1,000 beds to be built by the private sector on public hospital campuses is beginning to strain at the seams.
The consortium considering development of private hospitals on the sites in Letterkenny and University College Hospital Galway has decided that enough profit cannot be made because of competition from other private hospitals in Galway or the lack of capacity for profit in Donegal.
This emphasises the main mission of investor-owned hospitals, making money, as distinct from the primary mission of public hospitals, patient care. The appropriate attitude of investors is the need for a return on investment and if that cannot be made, then investors are bound to indicate that they cannot provide the 1,000 or more beds our public hospitals require.
The reason the Minister embarked on this plan was to create beds in public hospitals by shifting private beds in public hospitals to co-located private hospitals. One should ask did the Minister actually have an analysis performed to determine the appropriateness of this plan and a value for money assessment for taxpayers?
Many taxpayers do not realise that their taxes are being used to help build private hospitals with modern infrastructure that will primarily serve the 50 per cent healthier and wealthier members of society with health insurance, while the less well-off members of society will continue to be cared for in many public hospitals with antiquated infrastructure, not suitable for modern medical care. Is there something wrong with ensuring modern hospital infrastructure for less well-off members of society, who in general are less healthy and more likely to need health care?
The private hospital sector already has excess capacity in certain areas and the creation of a further 1,000 private beds will further increase this. Of course, additional capacity is needed to further develop another aim of the Minister and her party - competition in hospital care.
There are some potential pluses but also many minuses to competition which I cannot fully elucidate in this article but they include: inferior quality in patient care, inequity, and an undermining of clinical independence in the medical profession.
Why has Government not considered a commission to evaluate the impact of both enhanced privatisation and competition in healthcare similar to that set up by the Swedish government, who decided on the basis of the commission's report in 2004, not to proceed with any further privatisation of its hospital system?
The Government's encouragement of private sector investment in healthcare has generated interest from US-owned for-profit investors. The public should be aware that that there has been a history of fraud and maladministration in some US hospital investment companies.
Does the ethos of American for-profit hospital corporations manifested in the eighties and nineties still exist and has the Government considered the impact of the corporatisation of healthcare in Ireland? Investor owned hospitals in the US have been found to provide inferior quality and more expensive care than not-for-profit hospitals.
Of course the co-location of private hospitals on public sites has advantages. They include: reduced capital outlay for government - particularly valuable when governments are constrained by EU borrowing limits, clearly not the case in Ireland; sharing expensive technology and intensive care facilities; hotel type facilities for patients;increased health sector employment; innovation in health care delivery; greater financial returns for investors and income for doctors who have invested in these hospitals; reduction in waiting lists in the public sector and reduced government subsidisation of the private sector by the transfer of privately insured patients to private hospitals.
The disadvantages are none the less very significant and include: higher health insurance premiums from full cost charging in private hospitals; higher total healthcare costs resulting from the well documented increased utilisation in the private sector and a higher rate of spending growth on healthcare as a percentage of GDP than overall GDP growth resulting from higher healthcare costs.
This results in reduced sustainability of healthcare spending; increasing inequity as a result of quicker access to hospital care for the privately insured or those able to pay and lower quality of care resulting from inadequate staffing because of pressure to make profits.
It should be noted that it also leads to inefficiency in public sector hospitals because of some publicly contracted consultants spending excess time in the private sector at the expense of the public sector. The latter is a feature of all healthcare systems with parallel private and public hospital care and has been confirmed by research in the UK and Australia.
Other disadvantages which have been highlighted by colleagues in the medical profession is the ongoing ability of our public hospitals to train junior doctors in the setting of the increasing use of the NTPF to fund treatment in the private sector.
I might have expected a Blair type Socialist leader to consider getting the private sector in a public private partnership to build public hospitals that at least would serve all of the people irrespective of their income or health insurance status.
Dr John Barton will be a Fine Gael candidate for Galway East in the next General Election. He is a consultant physician at Portiuncula Hospital in Ballinasloe, Co Galway.