Madam, - We fully agree with Dr O'Ferrall and Mr Tom O'Connor in their concerns about developments in private hospitals in Ireland (August 22nd). The concept of with-profit hospitals, where stockholders gain financially from the management of the sick, is inconsistent with the traditions of medical practice and of our profession. We are particularly concerned about practising doctors having shares in private hospitals, as appears to be the case in the United States.
The increased complexity and advancing technology of medical diagnosis and treatment are a major factor in the escalating cost of healthcare. We believe that there is an urgent need for more effective audit in all our hospitals if doctors are to maintain the confidence of the public. This is particularly so in the case of with-profit hospitals.
Our two-tier system of healthcare is incompatible with the true spirit of democracy in this prosperous country. We fully support Tom O'Connor and the Adelaide Hospital Society in the plea for a one-tier system. Thirty years ago the then Irish Medical Association proposed a compulsory health insurance service along the lines of some of our European partners. Those were early days but now we have the resources to provide such a service. Apart from other considerations, in terms of equity there is no alternative to a one-tier system. - Yours, etc,
DERMOT HOURIHANE, MD, FRCPI, FRCPath, Prof of histopathology (emeritus) TCD. RISTEÁRD MULCAHY , MD , FRCPI, FRCP, FFPHMI, Prof of preventive cardiology (emeritus) UCD. DONALD WEIR, MD, FRCPI, FRCP, FACP, Prof of medicine (emeritus) TCD, Roebuck Road, Dublin 14.
Madam, - May I add my voice to Mr O'Connor's, Dr O'Ferrall's and Dr Lynch's concerns about evolving health sector strategies.
Why is the State offering extraordinary returns to investors in the health sector when it can easily raise the finance at less than 3 per cent per annum? How can the Government justify subsidies of up to 47 per cent by way of tax breaks to investors in hospitals and, on top, having to make annual payments to these investors to cover rents, fees, dividends, interest and profits? It is nonsense for investors to suggest that the State would gain from the resultant PAYE and VAT as it would be getting these if it financed the hospitals in the first instance.
By any standards, Ireland already has an inequitable two-tier health system and the Minister for Health's current policies will result in a fragmented and highly discriminatory three-tier system. What is really needed is an uncomplicated single-tier system where care is based on need rather than capacity to pay. The Government has no mandate to develop a "for profit" health service and Opposition parties should, ahead of the next election, pledge to roll back all measures aimed at privatising key health services. They could also usefully address the need to convert the VHI into a form of compulsory health insurance for all and let a much-diminished private insurance industry concentrate on the private healthcare sector.
The Minister's plan to transfer beds from public to private hospitals is akin to rearranging deck chairs on the Titanic except that in this case they are being moved from steerage up to first-class. This measure is being presented as progress but it is, in reality, privatising and cherry-picking by the side door.
Instead of pursuing this zero-sum game, the Minister, her department and the HSE should review why Ireland's health spend (as a percentage of Gross National Income) has risen above the EU average notwithstanding that the proportion of our population aged 65-plus is only two-thirds the EU average.
Is this because we are more prone to sickness and accidents than our EU counterparts (e.g. drink- and traffic-related), or because we get bad value from existing services (over-payment and under-performance), or because resources are mismanaged (too many administrators and offices and too few doctors and beds)? Findings and needs, not ideologies, should govern strategies aimed at increasing rather than reducing equity. - Yours, etc,
BRIAN FLANAGAN, Blackrock, Co Dublin.