Madam, - Maev-Ann Wren's article in Saturday's Weekend Review on the Irish healthcare system was a very insightful piece on a hugely complex topic. However, there were two points with which I must take issue.
Firstly, it is not possible to end private practice in public hospitals as Ms Wren suggests. Seventy per cent of acute hospital admissions in Ireland are via A&E. How is it practical to exclude private patients from admission via that system? Besides, it does not make sense to argue on the one hand for centres of excellence and at the same time plan to eliminate a large proportion of the population (the privately insured) from those same centres of excellence.
What really determines the best healthcare, I believe, is not private versus public healthcare, but whether you are treated in a teaching hospital or a non-teaching hospital. Teaching hospitals nearly always have the edge: they have the infrastructure (multi-disciplinary expertise, staff, equipment, research facilities), they are forced to stay on top of the latest developments and they are almost always centres of excellence in one or more specialities. When you are seriously ill, you need that level of support for optimal care, regardless of your public/private status.
Having said that, the fact that private patients get quicker access to healthcare in Ireland is a fundamental problem that must be addressed. The suggestion of merging waiting lists within public hospitals is a good one. If we can make this correction, then the private-public debate would largely be a funding issue.
The assertion that the public system should not subsidise private patients sounds laudable, but private patients pay their taxes too and probably pay more tax than those who do not have private insurance, so who is subsidising whom? Nevertheless, I think we need to find an efficient mechanism to charge private patients or their insurance companies appropriately for the care they receive in public hospitals.
The other point with which I take issue is Ms Wren's contention that every patient should be treated by a "fully qualified doctor". The implication seems to be that every patient should be treated by an appropriately qualified specialist (consultant). While I agree there is certainly a case to be made for more consultants and better supervision of junior doctors, not everything a doctor does in a hospital needs to be done by a consultant nor should it be - there must be appropriate learning opportunities with real responsibility. Recently, nurse practitioners have been introduced in some locations: this means that nurses with specific training are allowed to treat certain conditions and may in the future prescribe medications. I think this is a positive move which will ultimately help to make the health service more efficient. - Yours, etc.,
ANNA McCABE, RSCN, RGN, MSc., Ivy Court, Beaumont Woods, Dublin 9.
Madam,- Maev-Ann Wren presents the choice facing the country as a matter of "Boston or Berlin". If that is the case, then I heartily wish Miss Wren would closely examine the healthcare system in Berlin and the rest of Germany. The key feature of healthcare here in Germany is that it operates almost entirely on commercial lines. The notion of free healthcare is so foreign to the Germanic mind that, when I try to explain to my friends and acquaintances here (even those of the political left) that people in Ireland think that healthcare can be provided free of charge, they think I'm inventing it. When I insist, they end up shaking their heads in disbelief that anyone could be so daft as to believe that something so valuable could be handed out free.
When you go to the doctor or hospital here in Germany, the first question they ask you is: "How would you like to pay?" The key structural factor that makes healthcare in Germany (and, I suggest, in France, the Netherlands and Italy also) so effective is the existence of a market in healthcare. In Germany, one has buyers and sellers of healthcare. The buyers are the patients and the Krankenkassen (health insurers) and the sellers are a wide range of private, semi-public and public health centres, surgeries, and hospitals. The one thing they all have in common is that they regard healthcare provision as a commercial transaction.
If one examines the healthcare systems in various European countries, one finds that those with relatively successful healthcare systems operate a market mechanism while those that are consistently in difficulties (the UK, Sweden for example) are those which try to pretend you can operate without any kind of market ("free at the point of service").
If Ms Wren really believes it's Boston or Berlin, then please let's have some more of Berlin's commercialism in the Irish healthcare system. - Yours, etc.,
Dr NORMAN STEWART, Steinebach, Germany.