‘Can I live without this?” Most of us ask ourselves this question every day. Be it that second cup of coffee, the “We’re on our way to the USA” World Cup 1994 T-shirt festering in your wardrobe or the hassle of your daily commute.
However, for those who cannot afford private health insurance, that question takes on a far more literal meaning, and often, the answer is no.
The grim reality of our healthcare system is that the difference between life and death can come down to your ability to pay for healthcare. This situation, striking in its unjustness, has defined our health service delivery for decades.
We at the Irish Cancer Society know from the many cancer patients and survivors who have shared their stories with us that our two-tier system of healthcare leads to divergent outcomes based on whether you can afford to pay for private health insurance or not.
Today we launched a report based on a survey of GPs across the country which sought their perspective on access to tests used to diagnose cancer. The findings are stark. We found that 88.5 per cent of GPs said that ability to pay affected a patient’s access to referral services.
Waiting times for MRI brain scans were estimated to be on average 20 times longer in the public system than in the private.
Public patients can wait up to 480 days for an abdominal ultrasound, while the difference in average waiting times between the public and private systems for abdominal and pelvic ultrasounds is 70 days.
It is fundamentally unfair that someone should be made to wait longer – and potentially have their life put at risk – purely on the basis of their financial status. And it’s not a small minority of people who are affected by this either. More than half of the population (54 per cent) currently don’t have private health insurance.
All the while, public waiting times disimprove. In the past five years alone, colonoscopy waiting times have increased by 129 per cent, with almost one of every two exceeding the agreed target waiting time.
Huge progress
This is not to say that cancer services and diagnostics in
Ireland
haven’t improved greatly. In the past decade, since the publication of the second National Cancer Strategy in 2006, huge progress has been made in the organisation and delivery of our cancer services, thanks in no small part to the
National Cancer Control Programme
(NCCP).
The NCCP set up eight clinical centres of excellence which have significantly enhanced the delivery of cancer treatment.
National tumour groups have also been established which developed improved guidelines for diagnosing cancers.
There has also been an increased emphasis on prevention and health promotion and a widening of screening services, while Ireland has led the way in public health legislation. Now, more and more people each year are surviving cancer.
Since 2005, the number of people surviving for more than five years after a cancer diagnosis has risen from 53 per cent to more than 60 per cent. Through our commitment to invest in world-class cancer research and ever-improving treatment options, Irish cancer survival rates will continue to rise.
However, driven by lifestyle and population changes, we face a 50 per cent increase in cancer cases on 2010 by 2025. Extended screening programmes and rapid access clinics for certain cancers have helped, but to deal with future challenges, we now have to redouble our efforts to ensure earlier diagnosis for public patients.
The Irish Cancer Society is recommending a number of short-term, practical solutions that will make a big difference in ensuring early diagnosis of cancer.
Making access to more tests available to people in their communities will result in earlier diagnosis of cancer; improved information-sharing would go some way to removing GP’s reliance on personal relationships with consultants to get tests done; new guidelines for referral for cancer tests would mean the right patients are seen at the right time; and the development of cancer symptom awareness campaigns would encourage patients to present earlier.
However, unless this approach is underpinned by commitment to ensuring equal access to a universal, publicly funded healthcare system, the inherent inequalities of our peculiar provision of healthcare will remain and many of those who cannot afford to pay will still be left behind.
Quality of life
The Irish Cancer Society believes that all citizens are entitled to the opportunity to live a long and healthy life, and the ability to pay for private health insurance should not determine your lifespan or your quality of life. We cannot stand by while this situation endures.
That is why we are committed to campaigning for universal healthcare. We are under no illusions as to the difficulty of seeing this implemented. It will not happen overnight but it must happen. It will require building consensus in civil society, with policymakers, politicians, clinicians, academics and most importantly the public, who deserve equal access to care when they need it most. Nothing less should be good enough for us.
Unlike that second cup of coffee, our health is not an indulgence we can do without.
Donal Buggy is head of advocacy and services at the Irish Cancer Society