Increased spending does not necessarily lead to better results for patients, the Pfizer/ Irish Timeshealthcare debate is told
THE IRISH health service has an exceptionally large budget which has very little to do with the provision of healthcare, Trinity College Dublin economist Dr Sean Barrett has said.
Dr Barrett said he believed the €16 billion annual State spend on health and the further €4 billion currently spent by consumers on private doctors, med- ication and other charges, did not represent value for money.
He said Ireland was now spending 15 per cent of GNP on health – the same level as the US and almost twice that of the UK. In return for this considerable spend, Dr Barrett said the health service had recruited 67 per cent more staff in the period since 1996, but the number of hospital beds had increased by only 13 per cent.
Speaking during the final Pfizer/ Irish Timeshealthcare debate, held at the Science Gallery in Trinity College Dublin last week, Dr Barrett said that since 1996 the number of medical staff had increased by 55 per cent, the number of nurses by a quarter, health and social care workers increased by 159 per cent, while the numbers employed in management and administration went up by 45 per cent.
The debate on the motion, “This house believes that reduced health spending should not lead to poorer healthcare”, was attended by about 100 people on Wednesday night.
Dr Barrett, supporting the motion, said consultants were richly rewarded and that their numbers had increased by 60 per cent.
“When they awarded the €250,000 contract to consultants, one of their representatives was reported as saying, ‘This is a Mickey Mouse of an award’. Let’s all go to Walt Disney if that’s a Mickey Mouse award for a 33-hour week,” he said.
He went on to say that consultants also earned a considerable amount for seeing private patients and that he thought “private practice in a public hospital is something that really has to be looked at”.
Dr Barrett pointed out that in St Vincent’s Hospital, Dublin, there were 479 beds, 150 consultants, a rate of 1.3 beds per doctor and 0.5 beds per nurse.
“We have one of the most expensive health services you will find anywhere. Compared to 1997 we have 114,000 people doing the work of 68,000. It has a voracious appetite for earning . . . It has a very large budget that has very little to do with healthcare.”
In response, Stephen McMahon, chairman of the Irish Patients’ Association, said that surely if the annual spend on health was too much, then areas such as mental health and cystic fibrosis care would not be lagging, and money would have been available to fund a cervical cancer vaccination programme.
Mr McMahon said patients were wary of the health system for four primary reasons: a lack of clinical governance; the risks from being prescribed medication incorrectly; the danger of poor management decisions; and the inequality of access to services.
He said if enough was being spent on health, public patients should not wait months for appointments which private patients could attend in a matter of days, should not spend prolonged periods on trolleys and time waiting step-down care, and should not be at risk of catching infections such as MRSA or C diff.
Speaking for the motion, Sean Byrne, an economics lecturer at Dublin Institute of Technology, said international evidence suggested that increased spending on healthcare did not necessarily lead to better results for patients.
Mr Byrne said medical care was a contributor to better health, but that other factors, such as increasing educational standards and broadening income levels, would generate better results in the long term.
He said there needed to be both a consumption and investment in people’s health and that, while personal tastes and preferences were a factor, those who looked after themselves were most likely to reap the greatest rewards.
Mr Byrne also noted the level of spending on health in the US and said extra spending did not necessarily benefit those who were sick. He said the majority of terminally ill children in the US died in hospital rather than at home because of the higher cost and higher intensity approach to healthcare there.
“There is this notion that if you have the technology and you have the facilities and the expertise they have to be used, and you can be shoved into them regardless of whether they are best for you.”
In response, Fine Gael health spokesman Dr James Reilly said recent cutbacks in spending had resulted in even worse results from the health service here. Dr Reilly said there was a 70 per cent increase in delayed discharges this year as facilities to move convalescing patients on to had been scaled back.
He said waiting lists were growing, more patients were spending time on trolleys and the number of cancelled operations and attempts to scale back the medical card scheme for over-70s were other unreasonable consequences of health cutbacks.
Dr Reilly said the HSE was founded in an “impossible” situation which resulted in about 3,000 people not knowing what their role was when the former health boards merged. This disorganisation, he said, resulted in scandals such as misread X-rays and undiagnosed cases of cancer. “That approach is anathema to me and [Fine Gael] wants to see real change,” he said.
Dr Reilly said patients should be seen as the central figure to healthcare and not as a cost burden, and that clearly the health sector was not operating as it should be if operations were being cancelled because of budgetary overruns.
In summation, the debate chairman, Irish Timesassistant editor Fintan O'Toole, said both sides seemed to agree there was "a great deal of waste, a great deal of inefficiency and a great deal of extravagance" within the current health system. He said it could be argued that if money were taken from the system, similar results should be achievable.
However, he said it remained to be seen if wastefully spent funds could be directed into more worthy practices or if reorganising spending could generate greater efficiencies while protecting the needs of patients.
When asked if they agreed with or opposed the motion, the vast majority of the audience indicated that reduced health spending should not lead to poorer healthcare, prompting Mr O’Toole to declare the supporting argument victorious.
