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Healthcare and ideology November 19, 2019

Posted by WorldbyStorm in Uncategorized.
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Two letters in the Irish Times about public and private in hospitals outlined some of the territory in that particular debate, though perhaps calling it a debate is too kind. The first from TJ McKenna argues that any changes are cosmetic, and that:

The current income received by public hospitals for the treatment of private patients is approximately €650 million per annum, approximately 15 per cent of the national hospital budget.

When this funding is no longer provided by private patients, usually through insurers, it will have to be replaced from government funds in order to maintain patient care in public hospitals at the current level. So what are the benefits to be expected in the provision of healthcare to public patients for this significant investment?

Private patients seeking comprehensive emergency care will find this only in public hospitals. A private alternative does not exist as there is very limited provision of emergency care in private hospitals, service being usually restricted to between 8am and 6pm, Monday through Friday. The capability to treat major trauma has yet to be developed in private hospitals. Outside these hours and at any time for major trauma, private patients are always treated in public hospitals.

Concluding first with this:

As there will be little or no change in the admission of emergency patients the impact of eliminating private patients from public hospitals will be limited to the consequences of the reduction in elective admissions.

And then arguing that:

Eliminating private patients from public hospitals will deliver on an ideological ideal but it will be associated with much less benefit than naively expected and at extravagant cost.

In the text he notes:

As Irish citizens, we are all entitled to access public healthcare.

Though no word as to whether that healthcare should provide as good or better than a private ‘alternative’.

But as Dr. Jason Carty of Tallaght Hospital in response has some interesting thoughts. For example:

Dr McKenna points out that Irish citizens are entitled to access public healthcare. The reality is that many Irish citizens won’t trust the public system, not because of the care within it, but because of the difficulties accessing and navigating it. It’s also true that some Irish citizens don’t know of their right to public healthcare, because they are so ingrained in the culture of Irish private healthcare. In Ireland, there is not the assumed right to free healthcare that I experienced with the NHS when living in the UK.

And he notes:

For over a decade, the National Treatment Purchase Fund (NTPF) has been using Irish taxpayers’ money to pay for the treatment of public patients in private hospitals, primarily to reduce waiting lists. For the 2019 budget, the NTPF will receive €75 million, €75 million that is not being invested in the public system but is being handed over directly to private hospitals. The NTPF’s very existence is as a result of failures within the public system. The status quo always benefits somebody.
I have no recollection of any private insurer contributing to the build cost of any public hospital in this country. Take the current children’s hospital: as it stands, when it will open its doors, on day one the private insurers will be able to profit from admissions without having contributed to its build. The status quo always benefits somebody.

He also notes on foot of the observation by McKenna that private hospitals have no set-up for major emergencies that ‘this isn’t a flaw, it’s a feature. That’s the way the private hospitals like it. It means that they can manage and make money from patients who are sick, but not catastrophically sick, and leave the patients who take time and money to the public system.’

And he notes:

If there is an ideology at play here, then for me it is the ideology that private healthcare needs to stand on its own two feet once and for all in this country, and stop scrounging off the public system.
The private system relies on the public system so much more than the general public perceive.
Even the advertising for private insurers and facilities plays on the bad news stories of trolleys and waiting lists.

I’ve never used the private system – my encounters have been with the public one and my experiences have been good, albeit it has taken a while to access certain procedures. For example I have to have colonoscopies every four or five years due to hereditary factors and the Mater public is excellent in respect of that. I’ve had reason to use A&E in the last four years and while it was no walk in the park the attention was excellent. However I have immediate relatives who have twice accessed the private system in the past decade or so and in each instance there were very strange deficits (including recently a person in post-op being left on a trolley for five hours because not a bed was there to be found). That’s anecdotal, and there are obvious issues as regards waiting lists. But it does seem more than passing strange that private medicine would co-exist within public structures and as evidenced by Carty, the idea that private companies would profit from entirely state funded builds is beyond belief.

But this, to an extent, reminds me of fee-charging private education, still supported by the state. If there is a constitutional bar on doing away with these entities so be it. But supporting them from the public purse seems bizarre, to put it mildly. And if that’s ideological, well, so it is, but no more so than an ideology that is comfortable with the status quo.

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