Madam, - The finding of the National Cancer Registry's report, Patterns of Care and Survival of Cancer Patients in Ireland 1994 to 2004, that colorectal, prostate and breast cancer patients treated privately had significantly better survival rates, confirms the widely held view that there is great inequity in access to good medical care in Ireland. Regional inequity was demonstrated by the notable geographical differences in survival, with patients in the west and south doing worst.
There is a solution to the socio-economic inequity: universal healthcare. Maurice Neligan (December 2nd) refers to Churchill's idea of "national compulsory insurance for all classes for all purposes from the cradle to the grave." This could be provided easily through an extension of the existing medical card system.
One of the things we learned from the post-Budget protests and debates is the high value that citizens place on the medical card. But what does a medical card actually cost?
Just over one quarter of our citizens are covered by the medical card, about half are covered by private medical insurance and one quarter have no cover. Only those with a medical card or with more expensive private insurance plans are covered for primary care.
The HSE board was told earlier this year that the cost of each new medical card issued in 2008 was €1,650.
This figure seems high, but most of the recipients were the over 70s who naturally require more medical care.
In 2006, the Adelaide Hospital Society's comprehensive study, Social Health Insurance: Further Options for Ireland, estimated the additional cost to the State for a "Rolls Royce" social health insurance scheme at €2.1 billion (or an extra 1.4 per cent of GDP). At 2006 prices, this works out at about €700 for each of the t hreemillion or so citizens who do not have a medical card.
The study estimated that the cost of medical cards for the entire population was €3 billion, or about €720 per inhabitant.
One of our private health insurers offers a plan that includes a private room in public hospitals or a semi-private room in most private hospitals, a partial reimbursement for GP visits, among other benefits, for €735 per annum.
Presumably, the private room advantage will gradually disappear, as new hospitals built in the future may be required to follow the single-room standard that is becoming the internationally accepted norm for all medical, surgical and obstetric hospitals.
A programme of nationalising existing private hospitals would accelerate that process and provide the capacity necessary to implement a national scheme.
Universal healthcare could be provided promptly and fairly inexpensively by the simple measure of giving a medical card to those who cannot afford it and selling it to those who can.
The scheme would remove most of the current socio-economic inequity.
Moreover, such a scheme would work well with established structures and would not involve a requirement to change the delivery system to the more expensive "contracting" model. It would hugely reduce administrative costs by largely eliminating the insurance industry from the entire equation.
And it would encourage greater use of inexpensive primary care instead of expensive hospital care.
If medical cards were offered to the public at €700, and did what they are supposed to do, they would represent excellent value for money. - Yours, etc,