Two-tier healthcare – who benefits?


Sir, – There is a lot of truth in TJ McKenna’s letter (November 13th) about private patients and public hospitals. He is correct when he points out that removing the patients in public hospitals who identify as private will not create a like-for-like capacity, as a significant proportion of those patients will still simply transfer to become public patients.

Dr McKenna points out that Irish citizens are entitled to access public healthcare. The reality is that many Irish citizens won’t trust the public system, not because of the care within it, but because of the difficulties accessing and navigating it. It’s also true that some Irish citizens don’t know of their right to public healthcare, because they are so ingrained in the culture of Irish private healthcare. In Ireland, there is not the assumed right to free healthcare that I experienced with the NHS when living in the UK.

The status quo always benefits somebody. There is no doubt that the year-on-year failures of successive governments to manage waiting lists, or the 500-plus admitted emergency patients left on trolleys every day, benefit the private healthcare industry in this country.

For over a decade, the National Treatment Purchase Fund (NTPF) has been using Irish taxpayers’ money to pay for the treatment of public patients in private hospitals, primarily to reduce waiting lists. For the 2019 budget, the NTPF will receive €75 million, €75 million that is not being invested in the public system but is being handed over directly to private hospitals. The NTPF’s very existence is as a result of failures within the public system. The status quo always benefits somebody.

I have no recollection of any private insurer contributing to the build cost of any public hospital in this country. Take the current children’s hospital: as it stands, when it will open its doors, on day one the private insurers will be able to profit from admissions without having contributed to its build. The status quo always benefits somebody.

Dr McKenna points out that private hospitals in Ireland don’t have a sophisticated set-up for dealing with major emergencies like trauma. This isn’t a flaw, it’s a feature. That’s the way the private hospitals like it. It means that they can manage and make money from patients who are sick, but not catastrophically sick, and leave the patients who take time and money to the public system.

If there is an ideology at play here, then for me it is the ideology that private healthcare needs to stand on its own two feet once and for all in this country, and stop scrounging off the public system.

The private system relies on the public system so much more than the general public perceive.

Even the advertising for private insurers and facilities plays on the bad news stories of trolleys and waiting lists.

The fundamentals of the Irish public system are strong. It requires leadership, investment, planning and vision to finally bring it up to speed. I still hope that will happen some day. I believe the investment needed to remove private care from public hospitals will pay dividends. When traditionally private patients realise which facilities and expertise only exist in the public service, one could hope it will lead to a better engagement from citizens about the benefits of a well-run, well-funded, independent Irish public health service for all. – Yours, etc,


Consultant in

Emergency Medicine,

Tallaght University


Dublin 24.