Part of the problem, or part of the cure - two senior doctors debate the place of profit in our health system: NO says James Sheehan. We canease the pressure on the State sector and encourage efficiency...
Current funding difficulties in the health service bring back memories of the 1980s. Working at St Vincent's Hospital and Cappagh Hospital, I was then faced with either accepting the cutbacks and reducing my work output from six to eight hip and knee replacements per week, to 2 per fortnight - a massive decrease in patients treated - or to explore the alternatives.
At that time 30 per cent of the population carried private health insurance but most could not avail of their private cover when ill, due to lack of adequate hospital facilities. Virtually all serious illnesses had to be treated in public hospitals. No intensive care beds existed in private hospitals. All cardiac surgery, most implant (i.e. hip and knee replacement) surgery, renal transplantation, heart transplants and virtually all major surgery was undertaken only in public hospitals.
Thus, those patients paying not only private insurance but PAYE/ PRSI/health levy, had to join a public hospital queue for their care. This caused further overcrowding of existing under-funded hospitals. If some of those patients with private insurance could be off-loaded to a purpose-built hospital dealing with complex high-tech procedures, then the waiting lists for all public hospitals would be diminished - thus the Blackrock Clinic was born!
Over the past 19 years many thousands of patients have undergone cardiac procedures, bypass surgery, complex joint replacements as well as a great variety of other surgical and medical interventions, and the Blackrock Clinic has earned its place in our medical hospital services as a centre of excellence.
In more recent years many State-funded patients have been referred for cardiac surgery, diagnostic procedures like MR scans and recently for PET scans - a recognition of the expertise and technology now being availed of by the entire community.
Much of this work is done by consultants who have no attachment to public hospitals. Other visiting hospital consultants attend in the hours available to them outside their contractual hours to public hospitals. The majority work long hours because we have a serious shortage of medical expertise in this country.
All accept that there is an urgent need to double the numbers of medical consultants, but our public hospital infrastructure will not allow or accommodate such appointments. Currently many doctors are unable to work at full capacity, due to curtailed facilities and lack of hospital beds. Thus, by appointing more public consultants we will propagate an inefficient system with more consultants delivering less patient services and costing significantly more.
The pace of medical development and the introduction of new technology move so rapidly, and the public system so slowly, that an approximate gap of up to 8 to 12 years occurs between the advent and availability of these services to patients in our hospitals. As frustrated, committed healthcarers, do we sit idly by, or ease the problem by attracting alternative funding and efficiency into healthcare? As stated by Maev-Ann Wren, I am "unashamedly unapologetic" for promoting an alternative system: - an independent healthcare hospital system.
Competition in all walks of life is desirable. How long did we suffer our monopoly national airline? The advent of competition cut staff numbers by 30 per cent, reduced fares in many instances by 80 per cent, and returned Aer Lingus to profitability! Never before have so many people travelled, for so little, looked after by so few.
Many believe that acute healthcare services can only be run by the State, yet how many State services do we expound as exemplary services, accountable, frugal and efficient?
Our two-tier health system has been rightly criticised. This is due to patients queue-jumping, by paying for services in a public hospital and displacing public patients on long waiting lists. This situation cannot be tolerated indefinitely. Yet these paying patients have first to revert to the public hospitals, due to the inadequate provision of modern independent hospitals.
Despite the rise in our population and in the percentage carrying private health insurance (now just under 50 per cent) there has been no increase in the number of independent hospital facilities. No private hospital has been built in the past 20 years. This situation is propagated by the Department of Health which indirectly forces privately insured patients to use public facilities and so contribute, a second time, to the funding of these hospitals.
Yet they already are entitled to these services by their PAYE/PRSI and health contribution. This diversion of VHI funding to public hospitals is effectively achieved by blocking VHI patients availing of their insurance in new purpose-built non-State-funded hospitals.
What is the role for private and independent hospitals in the future? All our citizens should receive a quality healthcare service by right. By whom this is delivered is not relevant, provided it is delivered to a high standard by medical consultants, rather than by junior doctors, with accountability, efficiency and value for money for our taxpayers.
If part of this service can be contracted to an independent sector on a competitive basis, citizens and taxpayers would benefit.
It is frequently claimed that such a system would deplete our public hospitals of medical consultant staff.Yet hundreds of our excellent medical graduates are working abroad because they have been unable to obtain public hospital appointments in Ireland. Large numbers of these would welcome the chance to return home to care for fellow Irish citizens at no cost to the State, in independent, fully equipped hospitals.
The simplest way to eliminate our two-tier level of service and to optimise our efficiency is for all citizens to carry universal health insurance, as suggested by the Labour Party, and at the same time to introduce competition and accountability into the service. Medical professionals of all grades should be accountable and provide a measurable quantity of service. With such a system, both patients and the taxpayers would be major beneficiaries.
New independent hospitals should develop in a controlled and orderly fashion. Tax incentives for hospitals have been criticised. Are hospitals any less important to a community than holiday homes, student accommodation, car parks, or inner city apartments, which receive similar tax benefits?
The independent sector can solve our acute hospital problems within a very short time frame, dare I say, at less cost, if the current obstacles to our development are removed and if the political will to tackle our current health problems is genuine.
- James M. Sheehan, FRCSI, Ph. D, is an orthopaedic surgeon and founder member of Blackrock Clinic