Increased investment is more essential in primary medical care than in the hospital sector in Ireland, a leading US expert said last night in a critical assessment of the Hanly report.
Prof Barbara Starfield said: "The Republic of Ireland is not a very high achiever in primary care; faced with a choice of hospital versus primary care investment, you would clearly pick primary care based on the research evidence."
Prof Starfield, director of the John Hopkins University Primary Care Policy Centre and professor of health policy management at the university said it was anti-equity to focus on secondary care.
She said there was evidence that to do so would disadvantage infants and younger people. "Is it right to sacrifice children to keep older people alive?" she asked. She questioned whether the Hanly group had its agenda set by US data "which is not normally the best evidence".
The National Task Force on Medical Staffing, the group who produced the Hanly report on the reform of the health service, appeared to have used research linking high volume of care with better outcome "inappropriately", she said.
Speaking to journalists before delivering a lecture com- memorating the 20th anniversary of the foundation of the Irish College of General Practitioners, Prof Starfield said: "Because research linking volume to outcome is procedure orientated, it is questionable whether this relationship is really valid."
Prof Starfield told the audience, who included Mr Dermot McCarthy, Secretary General of the Department of the Taoiseach, members of the interim board of the newly-established Health Ser-vice Executive and represen- tatives of other care agencies that an "8 per cent increase in the number of specialist physicians would be associated with a 2 per cent increase in mortality".
In contrast, a 33 per cent increase in the number of general practitioners would bring about a 9 per cent decrease in death rates. This would equate to 70 fewer deaths per 100,000 population.
And in a comment relevant to the current health reform proposals, she said "patients re- ceiving care from specialists providing care outside their area of specialisation have higher mortality rates for community acquired pneumonia, acute myocardial infarction [heart attack] and congestive heart failure".
The Hanly report has proposed the development of a core spine of larger hospitals in the State, delivering a full range of specialist services. Critics have questioned this approach and the implication that smaller hospitals will be downgraded as part of reforms. This view has been strongly challenged by the Minister for Health, Mr Martin.
Referring to research in the US, Prof Starfield said that a one third increase in the supply of family physician decreased the incidence of invasive cancer of the cervix by 10 per cent, and death from the condition by 20 per cent.