The Irish Times view on two-tier health system: Preventing unequal care

Imperative to implement Slaintecare vision of health not based on ability to pay

The VHI’s move creates a potential ethical dilemma for doctors: must they now inform their public patients of the availability of better treatment options in the private institution down the road? Photograph: iStock

The VHI’s move creates a potential ethical dilemma for doctors: must they now inform their public patients of the availability of better treatment options in the private institution down the road? Photograph: iStock

 

Existing inequities in our health system have been widened with a decision by Voluntary Health Insurance (VHI) to offer its members access to novel anti-cancer drugs that are not currently available to public patients.

The Republic’s long-standing two-tier health system has always offered advantages to those who can afford private health insurance. The latter has been the gateway to being seen more quickly by a hospital specialist, as well as access to private rooms and wider menu choices.

In general, necessary investigations are carried out sooner and a definitive diagnosis arrived at more readily than for public patients. But now, patients attending private hospitals will have access to a wider range of cancer treatments. It means public and private patients will not have equal access to all treatment options in Ireland.

Drug costs will continue to rise exponentially, putting pressure on public funding for new treatments

The VHI is entitled to offer greater benefits to its members and the decision to do so appears to be a commercial one aimed at creating a competitive advantage over its insurance rivals. It is difficult too to criticise any individual for seeking the best available treatment they can afford.

However, the VHI’s move creates a potential ethical dilemma for doctors: must they now inform their public patients of the availability of better treatment options in the private institution down the road? Or does non-membership of a particular insurance company render such a discussion irrelevant?

A further, and more subtle, inequity has also emerged: the Minister for Health has confirmed there will be no differentiation in the level of access to cancer drugs between public and private patients in public hospitals. It means a VHI patient may be treated differently for the same condition in public and private institutions.

Drug costs will continue to rise exponentially, putting pressure on public funding for new treatments. What the cancer care inequity underlines is the need for a societal debate about how to manage finite health resources. But most of all, it highlights the imperative to implement the Slaintecare vision of health where treatment would be based on medical need and not on ability to pay.

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