Sir, – The Government is pressing ahead with the new Sláintecare contract despite the rejection of the contract by the consultant bodies. This means consultants appointed to public hospitals will be paid a salary and will no longer have private practice rights within the public hospital. The Government hopes this will deliver care based on need not income, the single-tier system.
Unfortunately, the new contract will not deliver a single-tier system, as private practice in private hospitals will be allowed under the new contract. This practice will be funded by fees through private health insurance. According to research by the Health Equity Research Group in the OECD, private health insurance in Ireland is the single largest contributory factor to inequitable access to hospital care in Ireland. In addition, behavioural economics research shows that private health insurance fees incentivise doctors to give quicker access to care, increases patient satisfaction, and reduces waiting lists, while salaried systems, similar to that proposed under the Sláintecare contract do not incentivise efficient provision of care but actually promote patient dissatisfaction through long waiting lists, a plague within our public hospital system. The new contract will therefore ensure the persistence of care based on income not need, the two-tier system.
Politicians of all parties who agreed the Sláintecare policy also agreed that private health insurance should continue as a funding system because of their failure to recognise or indeed be properly advised of the impact of payment systems on doctors’ behaviours, and have thereby guaranteed the continued existence of an inequitable two-tier hospital care system.
Given the state of our inadequate public hospital infrastructure, inequality in Irish hospital care may increase as a result of the new contract in the medium term and may persist indefinitely based on the income incentives consultants receive through health insurance fees. A policy of health insurance for all residents of the State, with all doctors remunerated equally for patient care, would be the most appropriate method of delivering a single-tier system of hospital care. Patients would no longer be labelled as “private” or “public”, they would just be patients, having access to care based on need not income. The Dutch government successfully implemented that policy in the Netherlands in 2006 and it is a great pity our politicians did not do so here when the opportunity arose in 2011. – Yours, etc,
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Dr JOHN BARTON,
Consultant Physician
and Cardiologist,
(Retired),
Galway.