The mixing of private incentive and public interest at the heart of our health system creates an ungovernable twilight zone, Róisín Shortall TD will tell the MacGill Summer School tonight.

Deputy Shortall chaired the cross-party Committee on the Future of Healthcare which recently produced a 10-year blueprint for reform of the health service, called Sláintecare

She will tell participants at tonight’s session that Ireland’s health system has failed people, and that the Sláintecare reform plan is “the only game in town”.

Deputy Shortall, who is a former Minister of State for Primary Care, will outline the work of the Committee, the first to reach a political consensus on policy relating to an area of major public importance.

In her address, she will say:

“Unlike most developed countries, we in Ireland have never sought to identify the most appropriate model of healthcare for the Irish people.  A very disjointed, inefficient and inequitable system has evolved over the years, which fails to adequately meet many of the most basic care needs of the people.

“In no other European country are so many people denied access to services or forced into private health insurance. In theory, almost 40% of people are eligible for free public health care.  But the key word here is “eligible”. They may be eligible for treatment, but they are not entitled to it.

“Because in practice, many of the services they are theoretically entitled to either do not exist or are hopelessly inadequate. This is why people can wait years for a routine out-patient appointment to see a publicly-sponsored consultant.  And because of the grave shortcomings of the public health system, another 45% of the population feel they have no choice but to take out expensive health insurance, the premiums for which rise every year, just so they can be sure of access to hospitals and diagnostics that, in most cases, are already paid for by taxation.

“All service users, whether public or private, are faced with significant out-of-pocket expenses that have risen substantially in recent years, often to a catastrophic level, where many are denied access to essential care.  In the Irish context, the Inverse Care Law applies with brutal force – those most in need of care are least likely to receive it.”

Deputy Shortall will continue:

“Absurdly, public hospitals are given annual targets, rising year on year, for income generation from private patients. Meanwhile hospital consultants who are already paid generous public salaries are permitted to see private patients on the side, to top up their earnings.

“This mashing together of public interest and private gain creates a classic perverse incentive, paying publicly-funded hospitals and consultants to treat private patients ahead of those in the public system whose needs may well be greater.  Is it any wonder that we have 660,000 people on waiting lists for hospital services? The mixing of private incentive and public interest at the heart of our health system creates an ungovernable twilight zone. All we know for sure about them is that public money flows into them, and private money comes out, in the form of “top ups” and special payments for senior doctors and executives. How this alchemy comes about is, we are told, none of our business.”

The agreed Slaintecare plan proposes a move away from “our overly hospital-centric model of care – expensive, inefficient, far too prone to blockages and bad administration – and move instead to a system which puts the focus on primary and social care, close to where people live, and to the networks that sustain them.

“This means investing in primary care centres and community diagnostics, rather than forcing people to travel long distances to over-crowded hospitals to sit in emergency rooms which they don’t really need, or to access routine out-patient services. It also means recruiting the nurses, doctors and other key health professionals who can provide this much needed additional capacity in the community.

“In this way we can have a much greater emphasis on prevention and early intervention and ensure that the huge burden of chronic disease can be managed much more effectively in a community setting.  If we can make this switch we can achieve much better health outcomes and also much better value for money.”

Notes to Editors:

Tonight’s debate, Our Dysfunctional Health Service – Are we about to find the remedy? begins at 8.30p.m. Further details are available here:

The session will be live streamed here:

The Sláintecare report is available here:


20 July 2017

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