Austerity is tough but it must be fair

Hospital patients who do not have medical cards or private health insurance have been surprised, and often shocked, to learn that if a course of chemotherapy is prescribed for them they must pay €75 a day up to a maximum of €750 a year.

Legislation for this charge has been in effect, theoretically at least, for decades. But until very recent times, hospitals seldom or never insisted on payment.

That changed with the crisis in the Government's finances. Hospitals have had their budgets cut – at a time when patients find it harder to pay their bills.

Managements make concessions for cases of hardship, but the Irish Cancer Society finds that its provision of financial aid has risen by 36pc in three years, to €1m a year.

Managements now find themselves obliged to try to collect charges in advance, or employ debt collectors. As always in such circumstances, some debtors are genuinely unable to pay. Others could pay but will not. It is hard to distinguish between those categories.

The hospitals point out that so far nobody has been refused treatment because of non-payment. But being in debt weighs heavily on the minds of worried people. And it is unfortunate that the issue should have arisen at the present time. The Irish health service is far better than its critics like to admit. In particular, we have a very good service for the 30,000 people diagnosed with cancer every year.

In time, its merits will show themselves in reductions in mortality rates. In the meantime, however, the public await an assault, long promised but never made concrete, on incompetence and indolence in the Health Service Executive. Anything that undermines their confidence should be avoided.

What the service needs is not chipping away – a charge here, a ward closure there, a half-hearted attempt to bring the budget under control – but the radical reform which the citizens were promised, and were entitled to expect, at the time of the general election in February 2011.

Some ministers in the present Government seem paralysed by the magnitude of the financial crisis. This is extremely harmful, and quite unnecessary. A time of crisis is the best time to plan reform and begin to implement it. It is also a time to build on public consciousness of urgency.

People have shown themselves willing to accept austerity. That does not make them willing to accept cuts or charges, however small, which they regard as harsh and unfair.