Tánaiste Mary Harney has said she is committed to a health service in which public patients do not wait longer than private ones for treatment through the creation of a new type of medical consultant, who will treat public patients only.
In an interview with The Irish Times, Ms Harney said the success of her plan would lead to fewer people taking out private health insurance as they began to see the new, efficient service, available from public hospitals.
She rejected the view of critics, who depict policies she promotes, giving tax incentives to private hospitals, building such hospitals on the sites of public facilities, and not triggering risk equalisation in the health insurance market until a few days ago, as further embedding the two-tier health model.
The two-tier system exists already, she says, and she is unhappy with its socially discriminatory effect. "The reality is that if you have private health insurance or can afford to pay, you have speedier access to our health care system. And that's something I want to change."
Her current attempt to introduce a new hospital contract, under which consultants in public hospitals would do public work only, is central to this.
"It is the most effective way to ensure a public hospital is there to treat public patients, and that we enforce limits on what private work can be done in public hospitals." Under her new public only contract, consultants would never "show favouritism towards someone who has ability to pay . . . the contract is pivotal to reform because doctors decide what patients enter the hospital".
Ms Harney said there was no agreement yet with existing consultants on this, but she was determined to press ahead with her plan if there was not an agreement this spring.
The Tánaiste agreed that health costs will continue to rise as new and sometimes costly therapies and procedures emerge regularly to treat various ailments.
"There is no doubt health costs are rising rapidly. Ireland is very lucky to have the economic resources to be able to increase by approximately 10 per cent a year. It's not happening anywhere else in the world. To be honest with you it's only going to be paid for if the economy continues to be successful.
"It will continue to be paid for more or less on the same basis: A combination of private insurance, contributions from citizens paying for things and the tax base will be the bulk of it.
"That will continue to be the case and clearly if the economy were not to do so well and health were to continue to get the same proportion of resources," she said, not finishing the sentence. "That is why the whole focus of reform is to do things better, support innovation, which should deliver more services, presumably in a containable fashion."