A two-tier cancer care system

Sir, – You report that Michael McCarthy, University Hospital Galway consultant medical oncologist, is asking his patients if they have private health insurance, as they can now immediately access new cancer drugs, while public patients may have to wait two years for this treatment (“Public cancer patients being offered treatment that is second best to one in private system, conference hears”, Health, March 7th). He was concerned about the development of a two-tier system in cancer care. This system in fact has been present for some time, given a comment by the head of services and advocacy at the Irish Cancer Society, Donal Buggy, in 2016 that Ireland had two-tier cancer care. Sadly, this development follows in the steps of our two-tier system of hospital care for most health services since the introduction of private health insurance in 1957. General practitioners are used to such two-tier hospital care and are in fact relieved when patients tell them they have private health insurance, as this means they can obtain quicker access to hospital diagnostics and care for their patients.

Indeed, this access inequity was found in a 2004 study by the OECD’s health equity research group of 21 countries that found Ireland had the third most inequitable hospital system of the countries examined while the Netherlands had the most equitable. The OECD researchers found that private health insurance funding was the single largest contributor to this inequity. The 2011 Fine Gael/Labour government proposed a universal health insurance system for all that would have substantially removed this inequity. Unfortunately, a less than critically appraised 2015 ESRI report for the department of health on the plan, somehow convinced the then-minister for health Leo Varadkar to dispense with the former minister for health James Reilly’s proposals for equitable access to care.

A political leader with excellent leadership qualities would be required to implement the introduction of universal health insurance and rid us once and for all of our two-tier hospital system, previously described by Prof Sarah Burke of Trinity College, in her book on inequality in Irish healthcare, as Irish apartheid.

Unfortunately, for all its potential, Sláintecare will not achieve this, as the plan leaves private health insurance in place as a parallel funding model of private hospital care and will therefore continue to ensure privately insured patients, nearly 50 per cent of the population, faster access to diagnostics and care. – Yours, etc,