Mary Harney (Dublin Mid West, Progressive Democrats)

The Deputy appears to misunderstand what is happening. Everybody is entitled to access our public hospital system and I wish to see that continue. However, I wish to see patients selected into a public hospital system on the basis of medical need, not on the basis of whether they have private health insurance. This is what currently happens. There are 2,500 private beds in the public hospital system. Of the workload of one Dublin hospital last year, 46% was elective work on private patients. Approximately 31% of the hospital's accident and emergency cases were private patients. This is not fair to the public hospital system.

The public hospital system received approximately €200 million from insurers in 2003, although work valued at €581 million was carried out. This is not a good return. Private hospitals account for 40% of open heart surgery. I am not arguing that private hospitals are the panacea for all illnesses in the country. However, converting 1,000 private beds for use by public patients makes much sense from the perspective of the public patient. It does not make sense that some people can access the public hospital system more quickly than others.

Everybody is equal in the accident and emergency area. This is because no extra fee is given to the consultant on the basis of whether a patient has health insurance. This is a bone of contention with accident and emergency consultants. However, we cannot have preferential treatment at accident and emergency level. Unfortunately, if anybody has a financial incentive in preferring one patient over another, it very often happens.

To the best of my knowledge, in health care systems all over the world, including Sweden, one of the most socialised countries in Europe, many private operators have been brought in to run public hospitals.

I can imagine the reaction I would get if I announced that here but that is what they have done. The Labour Government in the UK has announced and begun to implement a policy whereby 15% of all elective work will be done by private operators. Patricia Hewitt, in an interview with the Financial Times yesterday, said it was for reasons of efficiency, so there is a role for both approaches. We must ensure the public hospital system treats patients and is not obsessed with whether they have private health insurance or are in a position to pay more than others. I cannot conceive any way to make that happen as long as there is an incentive to take one patient in preference to another, which is what sometimes happens. It is not satisfactory and leads to cancellations, difficulties and unnecessary delays for too many public patients.

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