Dr. Brian Turner:

Yes, but I certainly have not seen too many health economists in Ireland calling for reductions in bed numbers in recent years. In fact, most of them are calling for the opposite, that is, increases in bed numbers. The reduction in bed numbers in the 1980s and 1990s arose from the financial situation at the time. It was not necessarily something that was requested. It was more about trying to live within means.

In terms of health services having an insatiable appetite for money, it is an unusual service in being very much demand led on the basis that if it is built, people will come. We have limited means to provide health care, yet we have not quite unlimited needs for health care but very significant needs. It is rare to find a system where everybody can be treated within a reasonably short space of time when needed. There is always some rationing of health care. That is why it is necessary to have a waiting list because that is one way to ration it. Another way is on the basis of affordability but that gets into a two-tier system. Waiting lists are a rationing mechanism. That is cold comfort to those on waiting lists. Every country that I know of has some degree of waiting for medical services. It is a case of what is an acceptable way. It is not normal for somebody to wait two years for an outpatient appointment. That is very high by international norms. We need to bring that down.

To answer how other systems deal with demand, one of the reports often referred to in debates about international health systems is the European Health Consumer Index. On that index we do quite well in some respects. We need to acknowledge that we are getting some things right. We are joint eighth out of 35 countries on prevention and joint tenth on outcomes, but we are falling down on accessibility where we ranked joint lowest.