Restrictive practices limit access to top health jobs

The provision of a very limited number of college places for students to study medicine, dentistry and optics is constraining numbers entering these professions and acting as a barrier to competition among them in the marketplace, according to consultants Indecon.

They noted several restrictive practices in all three health professions but singled out dentistry for "significant restrictions on competition that have an appreciable adverse effect on consumer interests".

"We do not believe that these are justified by any potential benefits," the report said. It stated dental hygienists should be able to set up independently and denturists should be able to sell their products directly to the public.

"It is clear that the present system which restricts the direct sale of dentures to the public by denturists results in substantial cost increases facing consumers, as dentists may place substantial mark-ups on the cost of dentures," it said.

Controls on advertising by doctors, dentists and opticians was, the report found, a further barrier to entry into the professions.

The consultants said they understood the concerns of regulatory bodies in relation to misleading advertising but they felt, given the high standard of education and training of these professionals and the importance of their reputations, misleading advertising was unlikely to be "pervasive". They felt there was no reason why they couldn't advertise their fees, which would increase competition.

While the report noted that many of the regulations in the medical profession were appropriately designed to protect patient interests and were justified, some were not and prevented the medical profession from engaging in legitimate competitive practices.

These included: the length it took for non EU doctors to register in Ireland; the length it took to appoint hospital consultants in the public system and the manner in which GMS contracts, which allow doctors provide services free of charge to medical card holders, were awarded.

Indecon found it took on average 1.5 years for a health board to fill a consultant post through the Local Appointments Commission. It said this appeared "inordinate compared with most other public sector appointments and particularly compared with the norms prevailing in the private sector".

Patients should also have direct access to consultants rather than having to be referred by a GP, the report said.

It also expressed concern at the structure of Comhairle na nOspideál, the body that regulates consultant appointments.

"The composition of the board could potentially result in bias towards maintaining the existing size and composition of the consultant community rather than reflect the demand for specialist practitioners," it said.

It felt Comhairle should have a consumer/patient representative, as should the Opticians Board for the same reasons.

From confidential submissions, Indecon said it understood the manner in which GMS contracts were awarded had the potential to restrict entry of new GP practices into the market, restricting choice for patients.

The majority of new GMS lists went to assistant doctors in existing practices, they said, but they believed it should be possible for any qualified GP to apply for a GMS contract and no limit should be placed on the number of contracts awarded in a given area.

The tradition within the medical profession precluding the practice by GPs within limited liability or corporate structures was also, the report said, likely to constrain the entry of new and possibly more efficient practices into the market. This was true too for dentistry, it added.

Looking at optics, the consultants found the prohibition on the sale of ready-made spectacles unduly restrictive from a competition point of view. However, they noted the Minister for Health had drawn up proposals to address this.