The number of women with breast cancer seeking treatment as private patients has increased dramatically, the All-Ireland Cancer Conference was told.
This has coincided with a significant increase in the number of treatments given to breast cancer patients, according to analysis of Irish treatment patterns. It also indicates many patients travel to other regions to obtain chemotherapy services.
The findings had implications for the Government's Health Service Reform Programme, said Prof Miriam Wiley, who is head of the Health Policy Research Centre at the Economic and Social Research Institute.
She asked if current patient flows would be reflected in the new regional health structures. The figures raised the question of how best to structure a reformed health service to ensure equity of access for all.
The comparison of public versus private treatments for breast cancer in public hospitals here found private care increased at four times the rate of public treatments in the three-year period up to 2002.
Prof Wiley said that while most patients received surgery in their own areas, women with breast cancer were "going in different directions geographically to access chemotherapy".
Her analysis of data from the Hospital Inpatient Enquiry Scheme for 1999-2002 showed a 26 per cent increase in the number of chemotherapy treatments administered to breast cancer patients. An additional 10 per cent breast cancer surgery took place in 2002 compared with 1999. This occurred despite the designation of just 20 per cent of beds in public hospitals as private or semi-private under the 1991 Health Amendment Act. Prof Wiley said the findings raised questions about the appropriate ratio between public and private patients in the public health system.
"How is an appropriate public/ private mix to be determined," she asked. "Is it to be based in bed designation in public hospitals or on the proportion of the population with private health insurance?"
The analysis of where in the State women received breast cancer treatment found that there were significant "flows" from one region to another.
"In terms of patient movement, not everyone goes to Dublin," Prof Wiley told The Irish Times. While 85 per cent of surgical procedures for breast cancer patients in the North-Western Health Board area took place in the north-west, 6 per cent of treatments were in the Western Health Board area and 7 per cent involved travelling to the Eastern Regional Health Authority area.
Chemotherapy treatments for patients in the east, south and western health boards were largely administered within their own regions. However, a substantial number of treatments for patients in the Mid-Western Health Board area took place outside the region.