Healthcare and medical cards


Sir, – Claire Conlon (June 21st) wonders why we cannot have a free healthcare system for all funded by general taxation. Indeed, she asks “why not?” She makes the usual assumption, so often heard, that the problems in the health system are due to the inequity of those with money in their pocket being able to access treatment and diagnostic tests over those with the actual clinical need.

She goes further, however, by stating that poorer people will continue to die while those with money will have treatment that they “may not even need”, with no “external scrutiny” in private medicine. These are astonishing and serious allegations. She fails to present any evidence to support them, however. I have worked in both sectors, and auditing and regulation of practice is as thorough, if not more so, in the independent sector as it is in the public system. Furthermore, most private hospitals are subject to biannual investigation and accreditation through the independent, external Joint Commission International, which sets out clear guidelines and criteria by which hospitals should practice and function.

As for funding of the health service, voluntary health insurance is in reality a voluntary health “taxation”. It is paid in large part by people of modest means who have no faith in the public system, and choose the burden of extra taxation to look after their health and that of their families. It is not the preserve of those “with money”. Without the independent sector, the general taxpayer would have to absorb the extra cost for funding what is currently done in the private hospitals. Seeing as 41 per cent of all elective surgery is performed in this sector, this would run into several billions. This does not even take into account what the HSE is earning by charging insurance companies every time a patient with insurance darkens the door of a public hospital.

Of course, the direct taxation-funded model exists across the water, in the guise of the NHS. Anybody who thinks that this model can simply be replicated here is misguided. One has only to look at the state of general practice in the UK to see the problems that the NHS model presents. According to the Royal College of General Practitioners, patients can now expect a 14-day delay before being seen by their GP, and some will not be seen at all, but triaged over the phone by the practice nurse. Many NHS trusts are almost bankrupt, and services are being severely curtailed in many regions.

Ms Conlon obviously believes the state of the public health service is due to the existence of the independent private sector. She has put the cart before the horse. The independent sector has not caused the problem. It exists because of the problem.

Without the independent sector, the public health system would implode. The public sector needs to fix itself, with the resources that are currently at its disposal, and stop looking at others as the cause of its illness. – Yours, etc,



Association of Independent

Medical and Surgical


Beacon Hospital,


Dublin 18.