Families on average wage face paying more as they wait longer for treatment

With health spending set to break the €10 billion mark, we have come a long way in real terms in funding our health system

With health spending set to break the €10 billion mark, we have come a long way in real terms in funding our health system. A 187 per cent increase in money for health since 1997 is not to be sneezed at.

The main beneficiary of the Minister's largesse comes under the heading of information systems. At €60 million, it represents a 100 per cent increase in an area that will help drive reform.

The move represents financial backing for one of the Brennan Commission's key recommendations. But there the good news ends.

For the consumer, it is the headline increases in hospital and drug charges that will matter most. And these will especially hurt if you are one of those with neither VHI cover nor a medical card.

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Between 20 and 30 per cent of the population fall into this category. For them, a necessary visit to the local accident and emergency department will now cost €45.

It is a significant amount to find if you are trying to balance a tight household budget. If they are admitted to hospital, then an increased charge of a further €45 per night must be found. While it is capped at 10 nights, the charge still leaves a family facing a potential bill of €450 per admission.

With the first five nights of a stay likely to be spent on an accident and emergency trolley rather than in an actual hospital bed, it is only a matter of time before someone challenges the application of this particular charge.

Having emerged from the hospital stay, those without a medical card face an additional monthly bill of €8 under the drug payments scheme (DPS). At €78, the DPS payment has risen substantially.

The actual "take" from these three increases is low; it is a drop in the ocean in the context of a €10 billion health budget.

Despite a 19 per cent increase in funding for the General Medical Services (GMS) scheme, Mr Martin has ruled out any increase in the number of medical cards.

The percentage of the population covered by the scheme has been falling steadily for a number of years. It is now below 30 per cent, and the Estimates do not suggest a political ambition to reverse this trend.

What of the many recommendations contained in the three major health reports this year?

The only specific reference yesterday was a vague one saying "Funding will be provided for initial set-up costs for the interim Health Service Executive and, depending on progress in various aspects that require negotiation, for initial steps in the implementation of the Hanly report".

The use of the words "initial" and "interim" do not convey an image of a Department committed to the urgent implementation of Brennan, Prospectus and Hanly.

The National Treatment Purchase Fund (NTPF), however, continues to receive support. At €32 million, it is getting an extra 3 per cent next year, with the promise that 9,500 people who have been waiting a long time for public hospital treatment will be catered for.

In last year's Estimates, the NTPF was expected to treat 7,000 patients with €31 million. Allowing for the possibility that less complex procedures will be performed, this year's Estimate suggests an impressive efficiency on the part of the private sector which the public system would do well to emulate. It also indicates that the NTPF is here to stay.

In his statement, the Minister for Health said: "Within the overall allocation I will have the flexibility to prioritise certain areas".

This is much more vague than the commitments made last year. Then, he was able to specify funding for a national lung transplant programme as well as an additional €7 million for the cardiovascular strategy. Last year Mr Martin was able to promise an extra €29 million for cancer services.

This year an expected reference to ring-fencing funding for the expansion of radiotherapy services was not included.

Perhaps the Minister was stung by the failure to deliver on last year's promises on additional hospital beds. He promised 709 extra beds last November. A year later, the net increase is in the region of 350.

A substantial part of the additional €700 million in yesterday's Estimate is committed to paying for wage increases and the cost of benchmarking. Without this, the Minister would have had an additional €500 million to spend. Another problem is the continuing rate of medical inflation at 7 per cent.

For a couple with young children earning an average industrial wage, yesterday's Department of Health estimates offer relatively little.

The spectre of ill-health will continue to haunt them; a hospital admission or the development of a chronic illness by one of their children means significant additional financial pressures. And in a health system already marked by inequity and inequality, such pressures mean the child may have to forgo necessary medication and proper medical follow up.

The prospect of paying more for the privilege of waiting longer continues to be the reality of the Republic's health service.