Massive public investment is not a panacea for the health system; the private sector is more likely to deliver, writes Mark Redmond
In recent weeks there has been much discussion about the emerging influence of the independent, or private sector in Irish healthcare. I would like to refute some of the prevailing myths.
It has been suggested that the introduction of privately-funded facilities will deregulate healthcare to the detriment of overall standards of care. Independently-funded facilities in Ireland, beginning with the religious orders in the last century, have always been, and remain, at the forefront of Irish healthcare. Only eight Irish hospitals are accredited by the Joint Commission on Accreditation of Healthcare Organisations, which validates healthcare globally. All are private.
Furthermore, the Government can demand that new independent facilities be state-of-the-art, produce patient outcomes data and be fully accredited. The Department of Health/Health Services Executive (HSE) can, therefore, regulate not deregulate healthcare development. Healthcare standards and diagnostic/treatment modalities are constantly evolving. Healthcare systems need to be flexible and service-oriented. They need to be efficient, providing value for money, yet designed to deliver care of the highest quality in a patient-centred fashion.
Our current structures are not well adapted to meet our healthcare needs. Policy and strategic decisions are based on reviews, reports, national forums and health consultants, commissioned by government. Such reports are based on current evidence-based medicine; they can be influenced by vested interests, while interpretation and implementation are subject to alteration in the interests of compromise, consensus and political expediency. Significant delays can occur before final service delivery, which may well be outmoded at the time of introduction. Lack of accountability is inevitable. Recent events in our health service bear this out.
Privately-funded facilities, however, have the capacity to accommodate changes in medical practice. By their very nature, they are efficient and flexible. But they must make a profit in order to service debt and fund new equipment. They must constantly recapitalise to remain at the forefront of medicine. Unlike public facilities, private hospitals must be fiscally responsible to ensure their continued existence. Triad Hospitals Inc., the operators of Beacon Hospital, is a publicly-traded company which has never paid its shareholders a dividend. Any profits are reinvested in its hospitals.
While the availability of private health insurance has traditionally led to accusations of a two-tier system, the development of independent hospitals now offers the Department of Health/HSE an opportunity to purchase healthcare from either the public or private sector. Any new facility availing of capital allowances must provide 20 per cent of its beds to public patients and at a discounted rate.
In Beacon Hospital, up to 50 per cent of all beds can be utilised by public patients. In Beacon Renal, all patients are public, receiving dialysis funded by the HSE. By availing of independent hospital services for public patients, the Department and the HSE can actually prevent the perpetuation of a two-tiered system of healthcare. It has also been suggested that privately-funded hospitals cherry-pick the low-risk, highly reimbursing procedures, leaving the more complex cases to the public system. In fact, outside of trauma and transplantation, private hospitals perform similar procedures and care for a similar patient profile as public hospitals
The Department and the HSE can insist that new independent hospitals availing of capital allowances have A&Es, demonstrate similar patient case mixes as public hospitals and perform their share of higher risk, low reimbursing procedures.
Currently the majority of consultants with public contracts maintain a private practice, and, in the case of category one consultants, this occurs within the public hospital. By developing private facilities on public sites, Minister for Health Mary Harney can shift private beds out and generate more public beds at minimal expense.
The HSE would thus be in a position to formalise its arrangement with consultants for time spent in the co-located public and private facilities, as it attempts to establish a consultant-led health service. There could be a sharing of certain services, some financed by the private facility and others by the public hospital. The State could benefit financially from the long-term lease of the site and avoid much of the capital investment required.
Although there is general agreement that we require up to 1,000 new consultants, the public system cannot cope with this influx. Newly-appointed surgeons find they have no operating time, clinic space or other facilities to see and treat patients. It is no surprise that there is increasing difficulty in attracting doctors back to Ireland after their specialty training abroad.Beacon has attracted over a 100 Irish consultants. It has also been successful in luring significant numbers of consultants currently working in the UK, Europe and the US.
While it is valuable to examine private and public health systems abroad, it is equally important to recognise that each country is unique. The skill is to replicate the successful features of privately-funded healthcare expansion abroad.
Recent massive investment in our healthcare system has not yielded significant improvement. More money is not the answer. Ms Harney is correct in embracing the independent sector which is much more likely to deliver on our future healthcare needs. Over 50 per cent of our population with private health insurance seem to agree. It is time to see what the independent sector can deliver.
Prof Mark Redmond, is a cardio-thoracic surgeon and medical director of Beacon Medical Group