Catherine Shanahan: Crisis will level the playing field in terms of healthcare access

In a move heretofore unimaginable, patients will finally be treated based on need, and not ability to pay, writes Catherine Shanahan

Catherine Shanahan: Crisis will level the playing field in terms of healthcare access
Taoiseach Leo Varadkar during the launch of a public information booklet on coronavirus. The virus has, in the blink of an eye, done what successive ministers failed to do and created a single-tier health system, albeit temporarily. Picture: Nick Bradshaw/The Irish Times/PA

The Covid-19 crisis is poised to achieve overnight what successive health ministers have tried to do for years: Level the playing field when it comes to accessing healthcare.

In a move heretofore unimaginable, patients will finally be treated based on need, not ability to pay.

A virus has, in the blink of an eye, created a single-tier health system, albeit temporarily.

If it’s really that simple, why didn’t we do it sooner? Why have successive governments agonised over the complexities presented by moving from our two-tier system, where those who can afford private health insurance get seen, while everyone else joins a queue?

How has it been possible to effectively decide overnight that private hospitals are to function as public hospitals for the duration of the pandemic?

It’s been possible because, like death, the coronavirus is a great leveller. We’ve all seen the horrifying results of inaction or delayed reaction in countries like Italy.

We’ve all seen the footage of army trucks ferrying dead bodies to the crematorium, an image that could come to define the Covid-19 crisis, just as the picture of three-year-old Aylan Kurdi washed up on a Mediterranean beach came to define the Syrian refugee crisis.

When it’s a matter of life and death, everyone pulls together.

The Irish Examiner contacted the various representative bodies for nurses and doctors in this country and none was voicing any opposition to the Government’s unprecedented move.

The Private Hospitals Association (PHA) has rowed in with an absolutely “can-do” attitude, and are prepared to do whatever it takes to beat the pandemic with the framework of an agreement already in place, albeit with a couple of points to iron out.

The Irish Nurses and Midwives Organisation (INMO) Phil Ní Shéadhgha said they “welcome any moves to increase the public health service’s capacity during this crisis”.

“Defeating Covid-19 is a national effort — we’ll need the private sector involved too,” she said.

As it stands, the INMO is working to ensure that nurses and midwives in the private hospitals have their workplace rights fully protected throughout.

Ms Ní Shéaghdha said the INMO has written to Health Minister Simon Harris “seeking engagement on the employment implications for INMO members of this decision”.

The Irish Hospital Consultants Association (IHCA) said it was “a great move” in the interests of patients, that it would bring an additional 2,000 beds into the system.

Even private health insurers seem to be on board. In a statement, Insurance Ireland interim CEO Gerry Hassett said they would “work with the Government and the private hospitals to play a constructive role in supporting the public system during this crisis”.

“It is understood that the health insurance consultative forum will be meeting shortly to discuss the implementation of these necessary steps,” Mr Hassett said.

Right now, the overnight introduction of a single-tier system would appear to have unanimous support.

Róisín Shortall, the Social Democrat TD who chaired the committee that drew up Sláintecare — the Government’s blueprint for overhauling the health service — says events have shown that the principle of treating people on the basis of need — the central tenet underpinning Sláintecare — is truly the way forward for the health service.

What we are seeing now as part of the whole response is community services coming to the fore, which is central to Sláintecare.

“We are applying the principle of treating based on need rather than ability to pay, also central to Sláintecare. And we are seeing a magnificent response to the call for trained healthcare staff. All of that is necessary to deliver good healthcare,” Ms Shortall said.

The Covid-19 crisis has not only exposed the shortcomings of the health service, she said, but it has also shown what can be done “in times of crisis”.

“What we are now seeing is a public health system coming into place. I would hope that they [the Government] would take that approach going forward in the provision of healthcare,” Ms Shortall said.

“It is very hard to see a return to the two-tier system.”

That remains to be seen.

The De Buitléir report, published last August, examined in detail the complexities of taking private care out of public hospitals, less radical than what is being proposed now.

It agreed with Sláintecare that this would take around five years to implement.

There would be knock-on effects for private health insurers and insurance premiums. There would be knock-on effects for public hospitals which would lose the income from statutory charges on those who declare as private patients.

Hospital consultant contracts would have to be revised.

Similarly, taking private patients out of private hospitals — their raison d’etre — is not sustainable in the long-term. It may be reasonably straightforward to legislate in times of emergency, when everyone is pulling together, but once the crisis has passed, private hospitals will expect to return to treating those who pay because, after all, they are commercial entities, not set up to operate on a not-for-profit basis.

So while they’ve signed up to the Government covering their costs during the pandemic, they are doing so on the understanding that this arrangement is finite.

It’s understood the proposal is to contract-out the hospitals for two months, with the option to extend.

Similarly, private health insurers will be hoping for a return to the status quo. As health insurance expert Dermot Goode points out, they are not currently in possession of the full facts around this new arrangement.

“They haven’t seen the details yet, they don’t know if claims will still be coming in to them, they don’t know if they will still have to pay the health levy to Revenue which is €445 for patients on an open plan covering public and private hospitals, and €177 for those with public hospital only cover.

“They need to know what’s been agreed with the hospitals and they need to know the duration,” Mr Goode said.

They may have to wait another few days. The Irish Examiner asked the Department of Health yesterday when the legislation to take over private hospitals would be passed, whether final agreement has been reached with the private hospitals, if the staff of those hospitals would have the option to opt-out and what impact the move would have on private health insurance and the health levy.

The answer was short:

Very constructive engagement with the private hospital sector is ongoing and we hope to finalise the details in the coming days.

    Useful information
  • The HSE have developed an information pack on how to protect yourself and others from coronavirus. Read it here
  • Anyone with symptoms of coronavirus who has been in close contact with a confirmed case in the last 14 days should isolate themselves from other people - this means going into a different, well-ventilated room alone, with a phone; phone their GP, or emergency department;
  • GPs Out of Hours services are not in a position to order testing for patients with normal cold and flu-like symptoms. HSELive is an information line and similarly not in a position to order testing for members of the public. The public is asked to reserve 112/999 for medical emergencies at all times.
  • ALONE has launched a national support line and additional supports for older people who have concerns or are facing difficulties relating to the outbreak of COVID-19 (Coronavirus) in Ireland. The support line will be open seven days a week, 8am-8pm, by calling 0818 222 024

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