Sir,- the Department of Health released a statement during the Rotunda controversy which included a comment that the issue was not a question regarding choice and safety, as proposed by consultant obstetricians, but a question of delivering care based on need, not the ability to pay.
One of the eight fundamental principles of the 10-year Sláintecare plan published in 2017 is that care be provided free at point of delivery, based entirely on clinical need and that the new system must ensure equitable access to a single-tier system.
While the Minister for Health, Jennifer Carroll MacNeill, and politicians of all parties support equity in public hospitals through the public-only contract for hospital consultants, they are happy to accept more rapid access to care – two-tier care – for the 46 per cent of the population insured or cash-paying in private hospitals and clinics run or financed by the health insurers.
The OECD found that private health insurance is the main driver of inequity in access to hospital care in Ireland. It still is and was recognised as such in Sláintecare.
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The preferred model of funding recommended in Sláintecare to achieve the goal of care based on need not income is a single national health fund (NHF). After nine years of Sláintecare there is absolutely no sign of the NHF and no mention of this in the Sláintecare & Programme for Government 2025+ report.
This means that care based on income not need is and will remain rife in Irish healthcare. It is difficult to fathom how all political parties are unhappy about inequitable care in public hospitals but are happy with the status quo of private health insurance and out-of-pocket funding of inequitable care outside public hospitals. I find this contradiction unacceptable.
Universal health insurance was proposed by the 2011 government to address this issue but it failed to deliver this reform. This would have provided all healthcare based on need, as the Dutch health system achieved in 2006.
Pregnant women would have had a choice of hospital and consultant. In addition, we would not have had the unruly spat between the Minister for Health and the Rotunda. As a nation, we would have been closer to having a hospital and community-wide system delivering care based on need not income had the insurance programme been implemented, – Yours, etc,
Dr JOHN BARTON
Physician/cardiologist (retired)
Galway.
Sir, – I believe Fintan O’Toole’s commentary on the Rotunda issue (“Women believed they had to pay to be safe giving birth. Why? The Rotunda told them so”, June 9th) overlooks an important aspect of why some women choose private maternity care.
It is many years since I gave birth to my two children, one in Holles Street and the other in the Rotunda. On both occasions, I chose to engage a private consultant. My decision was not primarily about the hospital; it was about the consultant who would provide my antenatal care, whom I would come to know and trust throughout the pregnancy, who would attend at the birth, and whom I would meet again during postnatal care.
For my first child, I chose a male consultant because other women spoke highly of both his professional ability and his manner with patients. For my second child, I chose a female consultant for similar reasons. In each case, I made a personal decision based on confidence in the individual consultant rather than the institution.
The same principle has guided other healthcare decisions throughout my life. When I required two hip replacements, I chose the consultant surgeon who would carry out the procedures.
As patients, we recognise that professionals vary in experience, expertise and approach. Just as some teachers may be better suited to a particular student’s needs than others, patients often wish to exercise judgment in selecting the doctor in whom they have confidence.
That freedom of choice is one of the principal reasons many people pay substantial sums for private health insurance. For many patients, the ability to choose and develop a relationship with a consultant is not a secondary consideration – it is the central consideration. – Yours, etc,
PATRICIA BURBRIDGE
Harold’s Cross,
Dublin 6W.
Sir, – As a woman who has had her first child delivered in the public system, and two more children privately, I have been reading Fintan O’Toole’s recent articles with interest. I chose the “posh push” for my two youngest children because I believed my babies would not be safe if I didn’t pay thousands of euro to a consultant.
Why did I believe this? Because my first experience in the public hospital was unsafe. It was not because a hospital board told me so.
Does O’Toole really believe women fork out thousands of euro because they fall for the hard sell of money-hungry consultants? Could there be a chance they are willing to pay this money because of previous experience in the public system by themselves or anecdotally?
Do I believe there can be two levels of safety provided in the same hospital? Yes. Do I agree that private maternity care should be phased out in public hospitals? Also yes.
It would be beneficial if the conversation would move on to the differences between private and public maternity care, why women might feel unsafe in the public maternity system, what can be done to improve the public system, instead of patronising women who feel they have no other choice than to pay for private care. – Yours, etc,
EIBHLIN FITZGERALD
Passage West,
Co Cork.
