Sir, – Further to the news of Ireland's slippage of eight places to 22nd place in the 2014 Euro Health Consumer Index, the devil is in the detail ("Ireland falls in international health service rankings", January 27th).
The report is funded by an international healthcare corporation whose operations include setting up large primary care centres in the Europe and directly employing medical staff. This is a business model that has recently been proven to reduce the effectiveness of primary care compared to the Irish general practice model of smaller, GP-owned practices where continuity of personalised care is available.
Your editorial (January 28th) notes the multipayer model of universal health insurance (UHI) for funding national healthcare proposed by the Government, despite all the international evidence that it can be expected to increase greatly the proportion of the health budget diverted into administration. When UHI is combined with a fee-per-item payment system, it can also have the perverse effect of increasing inappropriate healthcare. This is due to the asymmetry of information between the healthcare provider and consumer, which facilitates the potential for supplier-induced demand.
The report does make some valid points, such as the unreliability of government-produced healthcare statistics. However, it then quotes an official Irish doctor consultation rate that is lower than the European average. The obvious reason for this is that European healthcare surveys are based on a patient’s four-week memory when Irish surveys utilise a one-year recollection, which is obviously subjected to much greater degradation. It belittles the vast amount of evidence supporting the value of GP gatekeeping as the most cost-effective way to improve the equity of healthcare access, reduce mortality rates, unnecessary emergency and outpatient department attendances, inpatient admissions and even unnecessary pharmaceutical use in favour of a single flawed study that attempts to review the effect of GP gatekeeping exclusively from a macroeconomic perspective. This is a quite clear example of how different levels of analysis yield different views in order to promote unnecessary, billable through insurance, consultant-led healthcare activity.
Another view the report offers is maintaining that outcomes are not that important relative to bureaucratic achievements or ease of access. It’s true that improved health outcomes are also dependent on education, social, employment and environmental changes but Ireland would have been joint third in this important category if we dealt with abortion differently. The marking favours rapid access to any GP rather than maintaining continuity of care, which is a better marker of patient-centred primary care. It also values rapid access to CT scans, when this could perversely promote unnecessary exposures to cancer-inducing radiation. It fairly assesses equitable access as determined by the proportion of healthcare costs not coming directly out of the patient’s pocket. Ireland is quirky on this point because of our medical card system providing free primary care access to the oldest, poorest and sickest 42 per cent of the national population in favour of the wealthier, more educated population. On other equity assessments, Ireland is rated near the best in Europe.
This report raises some valid points, but it also has a clear underlying agenda. – Yours, etc,
Dr WILLIAM BEHAN,
Walkinstown, Dublin 12.