Who will benefit by privatising Ireland's healthcare system , asks Sylvia Thompson
Irish Healthcare Reforms - for people or for profits? is the provocative title of a conference this Saturday in Liberty Hall, Dublin. Organised by the Health Services Action Group (HSAG), its stated aim is "to offer a platform to all to debate the merits and demerits of privatising Ireland's healthcare system".
The keynote speaker, Prof Allyson Pollock, professor of health policy at the University of Edinburgh, Scotland, is adamant that governments that provide public money (in the form of tax relief or otherwise) to subsidise the development of private hospitals are fundamentally working against better universal access to healthcare.
"In Ireland, there is already a healthcare system with huge unfairness and inequities and a two-tier system in which consultants work both in the public and private health services. But, once you subsidise services for those who can afford to pay for health insurance, you are not distributing the resources and money on the basis of need," she argues.
Prof Pollack, who has written extensively on how parts of the National Health Service (NHS) in Britain have been privatised, says that if a healthcare system aims to offer better healthcare for everyone, it can only do so by funding public hospitals and community healthcare services.
"The problem in Ireland is that there has never been a universal healthcare system because there has been a reliance on private charitable [ voluntary] hospitals," she says.
"The danger is that politicians will conflate [blend together] these voluntary hospitals with 'for-profit' hospitals and confuse the public about what is now being offered. There isn't any international evidence to suggest that healthcare provided for by the marketplace will improve the public healthcare system," says Prof Pollack.
Dr John Barton, consultant physician/cardiologist in Portiuncula Hospital, Ballinasloe, Co Galway and chairman of the HSAG, will also speak at Saturday's conference. He argues that the American, Australian and British experience of public private partnerships (PPPs) in healthcare shows the risks are greater than the rewards. "American research consistently shows that investor-owned for-profit hospitals, not alone are more costly healthcare but also inferior healthcare," he says.
Barton quotes Carolyn Hughes, professor of political science at the University of Toronto, who published a report on the effect of private finance on public healthcare systems in five OECD countries last year. "She says that what private alternatives do is they 'cream off' the less complicated cases," he says. "It is also likely that these new private hospitals will not significantly change the situation in our accident and emergency departments as private and public patients with emergency conditions will still have to go to public hospitals," says Barton.
Barton argues that there is a fundamental issue at play when healthcare is privatised. "When there is an economic motive added to healthcare, patients can be offered services that are not completely necessary and this drives up the cost of healthcare all round, creating a two-track system with one speed for private services and another speed for public services."
A session on the crisis in the A&E departments in Irish hospitals will be addressed by Madeleine Speirs, president of the Irish Nurses Organisation (INO), Dr Christine O'Malley, consultant in geriatric medicine at Nenagh General Hospital, Nenagh, Co Tipperary, and vice-president of the Irish Medical Organisation and Irish Times columnist and author, Fintan O'Toole.
Speirs argues that the difficulties affecting care of the elderly, community and other services continue to deepen as the health reform programme - hailed as a solution to many problems - has resulted only in even greater levels of inertia and indecision.
"The INO's experience of the health service reforms has been that instead of recognising, acknowledging and dealing with these fundamental problems, all of the time has been spent upon protecting and further enhancing management bureaucracies," she says, citing the flawed payroll system as an example of "scandalous waste of money".
"Imagine what a difference €150 million would have made to so many patients and frontline staff to ease the overcrowding in A&E and to the provision of care, with dignity to the elderly," she says.
She argues that tax incentives for those who wish to build and run nursing homes and small private hospitals will "further entrench the existence of a two-tiered system and the cost of this will only be seen when private health insurance increases by 500 per cent in another decade".
O'Malley argues that subsidising private hospitals is not good value for money and diverts public money and attention from the needs of the public hospital sector.
"In contrast, increasing the capacity of our public hospitals is expensive but valuable. Emergency admissions are the routine of work in the public hospital, accounting for almost 75 per cent of all inpatient admissions," she says.
"All cases, regardless of complexity, cost or inability to pay are treated. Improving our hospital service will not be quick or cheap but it can be done," says O'Malley.
"The private sector is not the answer. The balance of beds must come from a sustained and major investment in our public hospitals," she says.
• Ireland's Healthcare reforms: for people or for profit? is a day-long conference on Saturday in Liberty Hall, Dublin. Registration is at 9.30am. Cost: €50/€20/€10 Details on tel: 087 2250947 or e-mail: healthconf2611@yahoo.com