Dáil debates

Tuesday, 26 June 2007

 

Co-location of Hospitals: Motion.

8:00 pm

Photo of James ReillyJames Reilly (Dublin North, Fine Gael)

It is important first to re-emphasise to the Minister that 58% of the electorate voted against the proposal to co-locate private hospitals on public hospital land. Why did they do so? Perhaps it was because they realised this is a very expensive way of providing public beds. The tax base will cost up to €500 million. The loss of revenue from private patients may cost up to €700 million. How is the shortfall to be addressed in the public hospital system, not to mention the loss of valuable land that was put aside to accommodate the future expansion of public hospitals?

Furthermore, there is the matter of the haemorrhage of medical personnel, both doctors and nurses, this proposal is likely to cause from the public to the private system, and the likely increase in the cost of insurance, as the need for profit encourages more investigations and tests. When profit becomes the bottom line, patient care can only suffer.

Given the existing dependence of some of the newer private hospitals on the National Treatment Purchase Fund to keep them afloat and the assumption that this will continue and possibly increase, does this imply continued starvation of the public health system so that the taxpayer pays twice for treatment? Evidence from the New England Journal of Medicine reveals that outcomes for patients treated in for-profit hospitals are not as good as those in not-for-profit hospitals.

This measure will do nothing to address the two-tier system in our hospitals, it will only further entrench it. It does not make increased provision for the training of junior doctors and does not address the need for rehabilitation and continuing-care beds in the community.

It is important to note that Ireland remains one of the lowest investors in the area of health. A total of 7.2% of GNP was spent in the area of health last year while the average spent in other EU member states was 8.6%. Germany and France spent in excess of 10% of GNP and the United States of America spent 15% of GNP.

I have heard other Members mention the American system and the argument that our system is closer to Boston than to Berlin. There is no doubt that we should be concerned about what has happened in America where those on the lowest income are looked after by the state while those who can afford health insurance are catered for. However, a rapidly expanding number of Americans, up to 60 million according to some experts, have no health insurance, and for them illness represents financial ruin. That is something we must avoid here.

Furthermore, because health insurance is so expensive, employers in America buy health insurance from HMOs. This has resulted in a situation where neither the doctor nor the patient has any say in who treats who. In other words, the doctors are tied through their contracts with the insurers and they must treat patients who have a contract with that insurer. The patient is tied to the provider organised by the employer. Therefore, if an employer changes his or her insurer, a patient who has been attending a doctor for 20, 30 or 40 years, suddenly will no longer be able to attend that doctor unless the patient pays for the visit, the cost of which is prohibitively expensive.

To recap, 18,000 beds were provided in our hospitals in 1983, today only 13,000 are provided yet 500,000 more people live here. Patients still spend three or four days on a trolley in accident and emergency departments while waiting for a bed and they have to wait for years to see a consultant. It was disingenuous to formulate waiting lists on the basis of the length of time people have to wait for treatment after they have seen the consultant. This does not take account of the length of time — in some instances, up to three or four years — it can take before one sees a consultant. Patients provided me with letters they received from their local hospitals which indicated that they would be obliged to wait for such lengthy periods before obtaining appointments to see specialists and go on waiting lists.

In light of the points I have raised and in view of the total lack of clarity surrounding the plan, I ask the Minister to reconsider and to deliver to the hard-pressed public health system the remainder of the 3,000 beds the then Government promised to provide in 2002.

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