For-profit hospitals unhealthy

Some time in November 2002, the then minister for finance, Charlie McCreevy, had a meeting with a constituent of his, a GP in the Naas area.

As a result, the minister introduced a last-minute amendment to the Finance Act for the 2003 budget, giving new tax breaks for developers who construct private hospitals.

The entire debate on its provisions consists of 441 words, most of them startled questions from Opposition spokesmen who were clearly bewildered by the sudden proposal.

With no real explanations given, a vote was called and the Government TDs trooped into the Yes lobby. Around €60 million of public money had just been allocated to private-hospital developers.

This is the way one of the most profound changes in Irish public policy - the Americanisation of our health service - is being pushed through. A new private-health system - available to those with money, but subsidised by all taxpayers - is being constructed, with profound consequences for both the efficiency and the fairness of our health system.

This huge policy shift has become explicit with Mary Harney's announcement that the 3,000 beds promised for the system will be provided by taking the private beds out of public hospitals and building new private hospitals next to the public ones. The shift will be funded by huge tax breaks for the private developers.

Medical apartheid will be institutionalised at the taxpayer's expense. And this will be done with as little democratic scrutiny as possible.

The case for building a huge private sector in the Irish healthcare system is essentially an ideological one. It is an article of faith for Mary Harney that private individuals motivated by greed will operate more efficiently than public employees. By applying a market model to the provision of health care, the can-do ethic of the business world will replace the leaden bureaucracy of the public sector. Patients will become customers, shopping around for the best deals and the pressure of consumer choice will force the system to deliver high-quality services at the best possible price.

The problem, of course, is that patients are not customers, and there is no market in illness. No one chooses to get cancer or to have a heart attack. Sick people don't shop around.

They want to be made well and to be treated with dignity and compassion while their bodies are aching and their heads are full of fear.

Some ancillary aspects of a health care system - the nature of the food and accommodation, for example - can be regarded as matters of consumer choice, but the hard core is the application of medical skill to basic human needs. For the vast bulk of medical conditions, a patient doesn't choose a hospital the way a shopper weighs up the virtues of Tesco against those of Superquinn.

In any case, there is strong and consistent evidence that the profit motive makes hospitals less efficient and effective rather than more so. A major study published last month by the New England Journal of Medicine compares the standard of care at not-for-profit hospitals across the US with that at for-profit hospitals. The conclusion? "Not-for-profit hospitals consistently had significantly higher scores than for-profit hospitals".

A 2001 study by economists at Duke University, the University of South Florida and the New Jersey Institute of Technology - looking at hospitals that switch from non-profit to for-profit ownership - found that "mortality rates increased following conversion from government or private non-profit to for-profit status. By contrast, if anything, conversions from for-profit to either government or private non-profit ownership led to decreased mortality."

A study published in the Journal of General Internal Medicine in 2000 found that patients at for-profit hospitals are two to four times more likely than patients at not-for-profit hospitals to suffer complications following surgery and delays in diagnosing and treating an ailment.

Not only, however, are non-profit hospitals safer than for-profit ones, they are also more efficient. A study published in the New England Journal of Medicine in 2003 found that administrative costs represented 31 per cent of total healthcare spending in the United States, where the private system dominates - about double the proportion in Canada, where the public system is pivotal.

Harvard researchers have found that for-profit hospitals spend 23 per cent more on administration than comparable private not-for-profit hospitals and 34 per cent more than public institutions.

The American experience of private profit-driven hospitals costing more money to provide a poorer service is already being replicated in the UK as a result of New Labour's mania for market forces.

Irish consultants such as the neurologist Timothy Lynch, who have experienced the American system at first hand, are warning of the consequences of Mary Harney's plans here.

But the knives are out for public medicine, nevertheless, and unless the political system responds soon, the operation will be almost irreversible.