Micheβl Martin has won his battle but the outcome of the war - to secure comprehensive, equitable health services comparable with those in other EU states - still remains to be determined.
The Minister for Health's efforts to convince his colleagues of the need for extra health spending were rebuffed at a special Cabinet meeting at the Ballymascanlon Hotel last May, but with a 13 per cent increase in Government spending on the health services, he emerges as the victor in the division of spending for next year.
His colleague, the Minister for Finance, Mr McCreevy, is still grappling with his scepticism about devoting further funds to health. Having stated after Ballymasclanon that he was still "not happy" with health spending, he yesterday expressed sympathy for Micheβl Martin's efforts to introduce reform.
"There are many vested interests in the health area which have terrible clout and have used it on many occasions. I don't underestimate the difficulties of the Minister for Health."
Mr McCreevy declined to identify the offending interests. However, while acknowledging that extra health spending was required because of population growth and the need to "unwind" the cutbacks of the 1980s, he remarked that "spending has been quadrupled since 1992/93. I don't think the Irish people are that much more ill in that period of time."
Irish health spending was now "above and beyond other countries" in the EU and "up to the EU average," he said.
In fact, the increases won by the Department of Health yesterday still fall short of the long-term wish list proffered by the Department of health at Ballymascanlon. An increase in current spending of €793.59 million (£625m) next year compares with an estimated need during the term of the new health strategy to build to an increase of €2,539.48 (£2,000 m) annually. An increase in capital spending of £78 million compares with an estimated need of £6,000 million.
Although the Department of Finance has given no up-to-date forecast for GNP growth, it can be extrapolated, and from this it appears that public health spending (adjusted for international comparison) will rise to some 7.3 per cent of GNP next year compared to an EU average of 5.9 per cent in 1998, the last year for which international figures are available. If the population increases as the CSO expects, health spending per capita will rise by nearly 12 per cent, bringing it further above the EU average. However, this increase seeks to make up for decades of under-spending and much Irish healthcare spending is social spending, which would not be funded from the health budget in other states.
The Department of Health's press release explaining the destination of the extra funds makes clear that they will not necessarily translate into reduced hospital waiting lists. Of the €893.90 million extra which the department receives, only €387.27 million (43 per cent) is available for new service development. The remainder goes to keeping existing services running, meeting pay and pension increases for the existing workforce of 88,000.
The new services will come in a wide range of areas. Community care will receive €101.58 million, 35 per cent of the current funds for new service development. The acute hospitals will receive only €93.96 million, one-third of new service development funds. Primary care will receive €50.79 million.
Mr McCreevy could not have been accused yesterday of giving a rave review for the long-awaited new National Health Strategy. "Most of the ideas are continuations and expansions of existing programmes".
The strategy will reportedly endorse proposals from the Progressive Democrats to treat public waiting list patients in private hospitals or abroad. Mr McCreevy, whose last Finance Act gave tax relief to developers of private hospitals, yesterday commented that he welcomed private provision of healthcare. However, a recent ESRI study has pointed out that the admission of private patients to public hospitals is now growing at a faster rate than the admission of public patients. By subsidising both private patients' treatment in public hospitals and the displaced pubic patients' treatment in private hospitals, "the State is paying twice over for the provision of certain types of services".
With an election imminent the Government has again committed funds to health. The new strategy document will reveal whether it also intends to reform the two-tier system to ensure equitable access to quality care.