Private patients cause waiting lists

PRIVATE patients are taking up increasing numbers of beds in public hospitals, adding to public waiting list times, according to a new international study.

An OECD survey found that 30% of scheduled surgery in Irish public hospitals is given over to private patients, even though the figure is supposed to be just 20%.

The survey of 12 OECD countries, also found that Ireland has the highest rate of private health insurance (PHI), taken out by 48% of the population, compared with just 11.5% in Britain (1998) and 0.45% in Norway.

However, the authors of ‘Tackling Excessive Waiting Times for Elective Surgery: A Comparison of Policies in Twelve OECD countries’, warn that a high percentage of PHI coverage, is not a guarantee of success for reducing waiting times for public patients.

“Despite Ireland being characterised by a similar percentage of patients covered by PHI (48% of the population, compared to Australia at 44.1%), waiting times continue to be a cause of social and political concern.

In fact the percentage of patients waiting on the list more than twelve months in March 2002 was 38%,” the report said.

The report also warns that giving patients with PHI a choice to have their scheduled surgery provided in a private or public hospital, can exacerbate waiting list times.

“This may possibly generate a perverse incentive for public hospitals’ waiting times to remain high [because public patients waiting a long time for surgery may opt to go private].

“In theory, no more than 20% of public hospital activity should be devoted to privately-funded patients in Ireland. However recent evidence suggests that 30% of elective activity is privately funded in public hospitals.”

Ireland’s waiting list problem is added to by poor bed availability and the low number of consultants.

“In addition, although the gap in terms of real health expenditure (per capita) has been narrowed compared to OECD average, capacity in terms of hospital beds availability, and the number of medical consultants is still relatively low,” said the OECD report.

Moreover, allowing consultants to operate both public and private practices can also add to public waiting lists, the report claims, particularly if the consultant is salaried, rather than paid per procedure.

“When discussing the options with the patient, the surgeon [consultant] may be influenced by the effect of the decision on his or her personal income.

“Allowing dual practice by salaried surgeons (in both public and private sectors) may encourage some surgeons to lengthen the public queues, to boost the demand for their private practices.”

The report also questions the wisdom of pumping extra money into the health service in Ireland.

“The available evidence on the effectiveness of providing extra funding to existing public hospitals is ambiguous,” the report said.