Medical apartheid surely more shocking than €100 tax


JUST TIME for a quick crow about the survey which showed that Irish doctors in general practice are 22 per cent more likely to prescribe antibiotics for private patients. Not that this is a cause for celebration. But this column did discover that fact for itself some weeks ago, and published its results here on 21st November.

The column was sparked by Antibiotics Awareness Day. We used a couple of moles and a telephone and ended up arguing, pretty much by the by, that the business model, when applied to medicine, can result in the paying customer getting the inferior treatment. Or, to put it another way, public patients can end up with better medicine – if only by accident.

We elaborated on the social as well as the financial reasons for this. A GP practice is in effect a small business and no one wants to alienate their paying customers by refusing to give them what they’ve come for – antibiotics. The paying customers will have to stump up the money for a second visit if the forecast recovery does not take place. Most disturbing of all, perhaps, was the pressure felt by private patients, and forcibly communicated to their doctors, that they could not take any sick leave from what they felt to be their endangered jobs. Whether that time off was to look after their own health or to care for sick children, the very prospect of it was worrying for them.

Researchers at University College Cork Marion Murphy, Stephen Byrne and Colm P Bradley are to be congratulated on gathering statistical information between 2008 and 2010, from 171 doctors round the country, which absolutely supports most of what was reported rather casually here. They analysed 16,899 consultations, and their results were published in the September issue of the British Journal of General Practice.

The survey specifically supports the anecdotal evidence we obtained – that the strongest demand for antibiotics came from fee-paying parents for their small children. And indeed that children treated privately do get significantly more antibiotics – 10 per cent more – than the children of medical card holders. These differences are most pronounced , the UCC survey finds, between public and private patients aged between one and four.

I wonder if anyone is doing a survey on children awaiting surgery. I heard, from a health care professional who himself works the private side of the street, about one of his kids going in for a routine operation. The child was three, as were the other children waiting for operation.

“Three-year-olds fasting from midnight,” said this man thoughtfully.

“You can imagine.”

The children were bouncing off the walls as they waited their turn to be brought to the operating theatre. And it was the children whose parents were paying private medical fees who were taken down to theatre first. This fee-paying father witnessed that himself.

Isn’t this an ugly inequality, that sick children should be sorted in this way? Waiting for surgery is unpleasant, however old you are, and however the queue is organised. And of course anyone waiting for adult surgery in the Republic knows that, most of the time, it is the private patients who are brought down to theatre first. But for fasting children to have to wait the longest simply because their parents do not have private health insurance does seem unhealthy for the nation.

It is a small detail in the scheme of things, perhaps. But surely this sort of financial apartheid, upon which our medical system is built, is more worthy of left-wing outrage than the €100 household charge.

The €100 household charge is another lazy, sloppy injustice. Injustice always has the advantage of simplicity and convenience. The suspicion is growing among the general public that Ireland is unequal not only because of cosy cartels, but because of a whole lot of public administrators who just can’t be bothered coming up with, and monitoring, something as complex as a fair system.

This is the only explanation for why child benefit is still not means tested, even in the midst of our bankruptcy. It is the only reason why there has been no research done on a fair property tax; or, if it has been done, why it has been kept as a dirty little secret.

But we’re worried about what is left of our left as well. Maybe it prefers organising around the refreshingly simple issues. Those of us who remember Joe Higgins’s embarrassing protest against the introduction of bin charges are hoping that this is not so. The objections of the protesters were hardly worth building barricades for.

I vividly remember being told by some of the protesters I interviewed that they worked at Dublin airport, but had taken a day’s sick leave to fight for their rights. Happy days. Even at the time (2003) the bin charge protest was a sign of how little the Irish left had to say on any of the complicated issues facing the country. Its view of Ireland was so simple that it had been completely out-manoeuvred by prosperity.

Let’s hope that in the new year we move on from the Bob Cratchit social analysis which leaves us fighting only the battles that don’t require us to do too much thinking. And God Bless Us, Every One.

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