Will health spending ever be enough?


Sir, – I always enjoy Chris Johns’s offerings and he excelled himself on Monday (“November budget would allow better planning on how to spend our taxes”, Business Opinion, November 5th).

His piece included a couple of gems on health spending – “no amount is ever enough” and “the last constant of fiscal policy (is that) no matter what the budget for health spending, the overrun is going to be about €600 million”. And his observation on the UK has application closer to home – the public sector is fast becoming a health service with a few bits and pieces tacked on elsewhere.

A familiar refrain from the massive health bureaucracy is that it cannot reasonably be expected to come in on budget because health services are “demand led”. I think this means that people in need of healthcare cannot be turned away. But it ignores the uncomfortable truth that much of our enormous expenditure on health is directed at satisfying the supply side and has nothing to do with demand. That in turn explains why a country with a relatively young population has in relative terms one of the highest health expenditures in the world but can hardly claim to have a health service which is better than mediocre.

I will restrict myself to one illustration of the supply-side issues. On March 14th, you reported that the HSE would take from nursing-home residents in the Fair Deal scheme 80 per cent of the €5 per week increase in the old-age pension. The piece ended with the startling revelation that the HSE was paying nursing homes a maximum weekly price of €1,360 a week for care in a private or voluntary nursing home and €2,399 a week for care in a public nursing home. Needless to say, labour costs are the single largest expenditure in these facilities. It is not a stretch to say that our senior citizens in these homes were having 80 per cent of the planned modest increase in the old-age pension confiscated to subsidise the layers of fat we seem to have come to accept as part of the public provision of services. – Yours, etc,



Dublin 6.