Thursday 18 December 2014

No remedy for our health system ills

Published 12/07/2003 | 00:11

Unhealthy State: Anatomy of a Sick Society By Maev Ann Wren New Island ?17.99 Eilish O'Regan Maev Ann Wren does not tell us if she personally has taken out private health insurance. But, according to her reasoning in this book, if she has then she is something of a leech on the health service.

Unhealthy State: Anatomy of a Sick Society By Maev Ann Wren New Island ?17.99 Eilish O'Regan Maev Ann Wren does not tell us if she personally has taken out private health insurance. But, according to her reasoning in this book, if she has then she is something of a leech on the health service.

The title Unhealthy State: Anatomy of a Sick Society promises much at a time when we are at an important crossroads in trying to remedy the weaknesses which are dragging down our service - a service which provides life-saving, enhancing care to many tens of thousands every year, yet still manages to let down so many others.

Ms Wren is on record as a long-term critic of the two-tier system of hospital care. As she sees it, that system allows people with private health insurance to jump the queue ahead of public patients while enjoying subsidies in subscriptions, the cost of their accommodation and, indirectly, through specialists' soft working terms.

Nobody would disagree with the objective of trying to achieve more equitable access to hospital care for all. But the author, while high on aspiration, fails to put forward a convincing formula on how we would reach this holy grail.

For convenience, she cuts too many corners and there is too much reliance on the implied image of privately insured people as arriving at hospital dressed in furs and stepping out of BMWs. We are no clearer on how much better or worse the public health system would be if that great swathe of PAYE middle-income workers who are now barely able to pay subscriptions opted out.

The author leans heavily on the idea of switching to a form of compulsory health insurance. We would all be insured and the State paying the premiums of the lower paid. It would mean everyone would be entitled to the same benefits and the old apartheid would be no more.

Unfortunately, she is too flimsy in giving us proper figures. How much would premiums be for instance? And we would still not get away from the old problem of more State investment in the service.

There is little new in any of the facts and thinking in this book, mostly because Maev Ann Wren relies so heavily on a multitude of reports on the service going back several decades.

She quotes liberally and generously from many of these studies and unfortunately there is no shortage of statistics. But if the health service has been bedevilled by anything, it is an over-reliance on reports, studies, reviews, work groups and forums. Time and time again their recommendations have been seized on as new wisdom, only to find they are not implemented.

Any analysis of how we move forward must surely involve paring away all of that padding contained in so many reports which have left us us running around in circles for so long. The book's best strength is the research which has been carried out into how we inherited the structures in today's health service. The history of the public health system, consultants' contracts, cutbacks and political cowardice are truly illuminating.

But the book is written from a remove and despite the author's undoubted sincere and passionate belief in a fairer deal for the less well-off, it is just too impersonal. It bears all the hallmarks of somebody who has taken up camp in the study of their Dublin home, waded through mounds of reports and spoken to the usual suspects.

Most of those who are interviewed and quoted are at the helm of some agency or organisation. No effort appears to get an insight into those at the frontline, not just in the bigger hospitals but also the general and district hospitals around the country - all of which are facing an uncertain future.

The author devotes a chapter to the potent politics of hospital location but there is no sense of what loss of services will mean to the people of west Kerry or north Donegal. There is nothing more grating than hearing the usual chummy consensus about what is best for the provinces emanating from south of the Liffey notables.

It is also not possible to write about the hospital system without taking into account the rest of the health service. Only around 50pc of the health budget used to go on hospitals and it is now reduced even further.

What about services for people with a disability, the psychiatric service, orthodontics, child care, speech therapy? They exist in the shadow of the acute hospital system, frequently sacrificed in the funding share-out - but their fate is inter-linked and intertwined.

Eilish O'Regan is the Health

Correspondent of the Irish

Independent

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