Health insurance key to problem

SUSIE LONG died from colon cancer.

Earlier this year she told Joe Duffy on Liveline that she had waited seven months for her bowel test, while a patient with the same condition who had private health insurance waited three days.

Subsequently, Joe Duffy gave me time on his show discussing this issue, during which I explained the reasons why insurance and other aspects of our health financing system create inequity in access to hospital care.

Regrettably, such inequity is not surprising, as research carried out internationally by the Health Equity Research Group of the OECD and here in Ireland by the ESRI has shown that one of the benefits of health insurance is that it encourages doctors to treat patients quickly.

This results from the fact that insurance remunerates doctors through fees and fees are a financial incentive to get patients into hospital.

Prof Eddy Van Doorslaer of the Health Equity Research Group studied 21 OECD countries’ health systems in 2004 to ascertain which were pro-poor or pro-rich. He found that Ireland had the third most pro-rich system in respect of access to hospital doctors. He went on to determine what factors contributed to this inequity.

Not surprisingly, he found that private health insurance was one of the leading contributors to our system being pro-rich and therefore inequitable. To his surprise, but not mine, he also found that having a medical card was one of the other major factors creating this inequity. He could not understand why a card which entitled an individual to free hospital care created this inequity.

Medical cards are an insurance system against the cost of medical care, but they do not pay hospital doctors’ fees and are therefore a financial disincentive to hospital access.

It is a system I deplore and one that should be changed.

Our politicians have created this inequitable system and, with some exceptions in the opposition, seem content to continue with it.

They have failed Susie Long and her family and many other patients. Susie could have criticised the medical profession for the delay in diagnosing her condition, but she recognised that it was the politicians who created and continue to support the current financing system.

Although politicians and the health system failed her and her family, and despite their recognition of the inequitable value of private health insurance, both Susie and her husband had great courage, decency and principle in retaining a core belief that healthcare should be provided on the basis of need and not on ability to pay.

Our political parties have not forcefully made the case for change and the need for that change.

Is it because most of the members of the Dáil have private health insurance and recognise the inequitable benefits accruing?

Dr John Barton

Physician

Portiuncula Hospital

Ballinasloe

Co Galway