Debate at the annual meeting of the Irish Medical Organisation (IMO) was, unsurprisingly, dominated by the effects of the economic recession. It emerged that one- in-five general practices were forced to cut staff numbers in the last year, in response to a drop in State employment subsidies and fees. Doctors warned this could affect the quality of chronic disease management in primary care, with earlier and more frequent referral of patients to already stretched hospital services.
In addition to a well-established manpower crisis in general practice, there is now a growing shortage of public health doctors. Such is the current shortage of junior doctors in hospitals, emergency medicine consultants warned of the real possibility of closure for a number of the State’s public hospital emergency departments.
All of these recessionary realities are likely to affect patient care. But what of the direct impact of the economic downturn on people’s health? The meeting heard of increase in stress-related illness due to financial worries and job uncertainty. Drink and drug problems are also on the rise. There is anecdotal evidence of people postponing visits to their doctor until their symptoms are severe and of others unable to afford prescribed medication. Health inequity related to an inability to pay for treatment must not be allowed return to levels seen in the recession of the 1980s.
However, with €14 billion being spent on the public health service this year, it should be possible to improve the care of patients by offering better services for less money. This was the argument of Prof Charles Normand. He called for a change away from “incoherent patterns of entitlement”, by which certain poorer income groups receive subsidised drugs but not free GP care, while others benefit from subsidised GP visits but must pay in full for their medication. He also cited evidence that cervical smear testing need only be repeated every five years, rather than the current practice of every three years.
The IMO also launched a position paper on universal health coverage. It argues that Government policy encouraging private health insurance has led to concern that we are veering away from a European model of healthcare. Mindful perhaps of Fine Gael and Labour policies in this area, the organisation stopped short of favouring a particular model. However, following the recent seismic changes to healthcare by the Obama administration in the US, its call for a public debate on universal health coverage is timely.