Editorial: 'Remedy for fixing health service is political will'
The reason our healthcare system has long been something of an outlier within Europe is because private care can be had in public facilities. This advantages those with money in that they may queue jump and access earlier and better treatment.
The anomaly facilitates a type of apartheid according to its critics; a two-tiered system in public hospital care gives private patients privileges over public ones.
A system that may be responsible for unequal outcomes depending on one's resources would not be tolerated in most countries if taxpayers' money was in play. The thing is these inequities have become somewhat endemic. The system has evolved around them and fixing them is a lot more difficult than simply identifying them.
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A report published yesterday by an independent review group produced by Dr Donal de Buitléir has zoned in on the challenge of removing private care and places a cost of €650m on it.
It would also take a decade to deliver.
In 2005, then health minister Mary Harney also grappled with but made no progress with the issue through her "co-location proposals". This might have opened the way for developers to build private for-profit hospitals on the grounds of public hospitals.
There have been other efforts to provide a level playing field for public and private patients. Curbing private beds in the public hospital to 20pc of the total, a new consultants contract and the introduction of a common waiting list were all steps in the right direction but the fundamental unfairness remained. The core inequity persists.
While there is a differential for what doctors are paid between public and private patients, the two-tier system is locked in. As we have seen, the problem has not gone away just because we ignore it, as the voluminous other reports on issues within the health services gathering dust can testify.
Sláintecare was engineered to be the silver bullet for fixing the health services, the blueprint to that illusive level-playing field. Central to this would be the elimination of private practice from public hospitals, it found.
But how do you persuade doctors to forsake their private consultancy suites and put their trust in the State? Compensating them for lost income could be enormous. More doctors may leave.
Will our public hospitals be able to handle the extra patients? All of these questions need answers.
Legislation would be needed to ensure public hospitals be used exclusively for public patients. All this will take time and be both costly and complex, as noted by Health Minister Simon Harris.
If, as acknowledged, the current system is unfair it is not right that we persist with it. But governments producing well-intentioned reports without the requisite political will or resources to act on them is far from a remedy.
It is akin to doctors making expert diagnoses and then going on sabbatical for decades, leaving patients out of the picture.