Mary Harney is exacerbating the current widely differing benefit to the health service of payment for public and private patients, writes Liz McManus
'It is the answer to our prayers. We couldn't have written it better ourselves!" was the response of one private health operator to the Government's plan announced last Thursday to facilitate private-sector investment in hospital beds.
Whoops of jubilations coming from that quarter should not surprise. Private healthcare is a lucrative and growing business, and for those investing in it Mary Harney's announcement is all good news.
Double-digit returns are on offer to investors, but what about the patients? Or for that matter, what about the taxpayers who have witnessed a significant growth in health spending without seeing significant benefits?
In this newspaper, Richard Bruton TD has already presented a critique of the costs to the taxpayer of the Government's largesse. Remarkably generous tax reliefs will lead to a cash return of €62,760 for every €75,000 invested. He reminds us of the lessons that need to be learnt from the Beaumont hospital car park, a public-private venture that ended up costing the taxpayer €13 million more in tax breaks than if the State had built it.
So what about the patients? The argument put by the Minister for Health is that the removal of private beds from public hospitals will free up space by the creation of 1,000 in private hospitals. Superficially the idea has its attractions. But its pitfalls are many; not least, that it can create greater inequality and less value for money. The US model which Ms Harney clearly favours is excruciatingly expensive and grossly unfair to those people who do not have health insurance. Our model is different. That so many people take out health insurance (52 per cent of our population) is an indicator of dissatisfaction with rates of access and care.
But it does not alter the fact that every person in Ireland is eligible in law to a public hospital bed should they need it. About 70 per cent of patients are now coming into the acute hospital service through accident and emergency departments, and there is no differentiation made there. When they access a public bed they cannot be shifted off willy-nilly to a private facility just because they have insurance cover.
For many, the care in a public hospital is deemed better, and they may simply make that choice particularly if there are any additional charges arising in the private facility. Balanced billing, for example, which is a distinct possibility for insurers seeing their costs rise. In fact, if health insurers' costs continue to rise to pay for the double-digit returns to investors along with the Minister's failure to introduce risk equalisation, many people may simply opt out of insurance altogether.
The likelihood is that the private hospitals will provide only what makes money for them. Certainly A&E of the kind we see in major public and voluntary hospitals won't be on offer. Interestingly, in the US a private hospital is required to provide A&E services, but this is not the case in this country.
Some hospital consultants are apprehensive, too, that private hospitals have no incentive to engage in continuity of care, yet what is needed is greater, not less, liaison between hospitals and community care.
For public and voluntary hospitals their private beds provide badly needed income which will not only be lost to them, but will not be replaced by the Government.
Kevin Kelly, acting chief executive of the Health Service Executive, admitted recently that there is a shortfall in funding of almost €200 million for this year. Its impact can't be fully assessed because this Government has closed down almost every source of information. Parliamentary questions go unanswered, waiting-list statistics are a secret, health boards are abolished - a virtual blackout on accountability for parliamentarians and the press alike.
The Labour Party has argued for a different approach. The key is to ensure that the money follows the patient in all cases so that the division between public and private is eliminated. Universal insurance is one way to achieve this. The Minister is doing the opposite. She is exacerbating the current, widely differing benefit to the health service of payment for public and private patients.
There is a role for the private health sector in building up capacity but, unless all patients are covered by universal entitlement to access it, where Mary Harney's decision leads is to a deepening - not a lessening - of the two-tier divide in our hospital care.
• Liz McManus TD is Labour Party deputy leader and spokeswoman on health