The announcement of increased hospital and drug charges is yet another sign of a health system struggling to keep its head above water.
With the cost of visiting an accident and emergency department without a letter from a general practitioner to rise by 26 per cent, and the threshold for the drug refund scheme set to increase by 22 per cent, the price of medical treatment will multiply well ahead of inflation.
Coming soon after reports that the VHI is looking for an 18 per cent increase in subscriptions from September - if granted it will be its largest single increase in two decades - it is clear that the health service is set for a period of retrenchment.
Although hospital waiting lists have declined by five per cent in the year to March, this reduction comes at the end of three years of relative growth in funding. But a deeper analysis of the latest figures reveals a significant increase in waiting times for some specialities which must be a cause for concern. Certainly the election promise by Fianna Fáil that waiting lists would disappear after two years seems unlikely to be met.
While the private health insurance increase - if it is confirmed - will mean that some members will be unable to afford the annual subscription, the impact of hospital and drug charges will be much greater. These increases will have most impact on what has now become the most vulnerable group within the health system. For families earning just above the income limit for medical-card eligibility, low-paid workers and some people in receipt of social welfare, payment of €65 a month for prescribed medication represents a significant proportion of household expenditure.
There is some research evidence to suggest that families under financial strain do not seek medical help until late in an illness. Concern has also been expressed about their compliance with medication for chronic illness, with cost being a major deterrent. The potential, therefore, for these large increases to actually affect people's health is significant.
A proportion of accident and emergency attendances are undoubtedly inappropriate. The decision to increase attendance charges, for those without a GP's letter, can be defended on these grounds. At €40, the new fee is now similiar to that charged by urban GPs for a consultation and should encourage more appropriate help-seeking behaviour. However, last week's increases have compounded the Government decision, early this year, not to significantly increase the income threshold for medical-card eligibility. With less than 30 per cent of the population entitled to free healthcare, the number affected by the latest increase in charges is greater than it might have been.
Both the timing and the nature of the Government's announcement is questionable. How much more equitable it would have been if it had announced a modest increase in the health levy, with a guarantee that the extra taxation would go towards an expansion of our much beleaguered public health service.