Health polices and services need to be "politics proofed" against parochialism, the National Economic and Social Forum was told. Prof Muiris Fitzgerald of UCD School of Medicine said local hospitals could not be "all singing, all dancing" providers of all healthcare specialities.
Prof Fitzgerald was addressing a session dealing with equity in the health services.
At the forum, the chief executive officer of the Eastern Regional Health Authority, Mr Donal O'Shea, said at least one third of procedures, provided in the ERHA, are for patients from other health board areas.
He also warned that no matter "how we play around with the figures", many people "are going to be waiting a long time for services" unless up to 2,146 extra acute beds are provided by the end of the decade, based on current performances.
Up to 700 non-acute beds are also needed.
Prof Fitzgerald said that "local politicians and communities are seeing only their small hospital needs as the most important". They are not seeing the bigger picture and as a result were losing out in terms of healthcare services.
"Choices have to be made," he said. This did not mean that local hospitals had to be closed but that services needed to be centralised with one centre that was "larger than the others" in each region.
Because of five-seat constituency politics there is an "incredible situation" where one small hospital cannot increase its capacity by 10 beds without the demand for the same increase in each of the other hospitals or else "everyone takes to the streets ".
Policies in the forthcoming health strategy need to be "politics-proofed" he said.
A new standard needed to be set in order to be able to deliver quality healthcare.
"It does not mean closing hospitals but changing the mix of services they provide," he said.
With proper regional centres people will no longer need to go to Dublin and Cork for treatment, he added.
Mr O'Shea said that 40 per cent of all hip replacements, performed in the ERHA region, were for patients from other health board areas.
He added that of 45,000 procedures carried out in 1999, 63.8 per cent were for the eastern area and the remainder were for other health board patients.
Referring to waiting lists he said that the number of people waiting for treatment was not the issue but rather "the length of time before the bulk of people get a service".
He said that in 1980 there were 7,066 acute hospital beds and this had dropped to 4,884 by 1998.
Yet the population had increased by half a million people, the equivalent, he said, of two more health boards.
With the current rate of performance there is a need for 2,146 beds by the end of the decade, he said. Even allowing for increased efficiencies and shorter hospital stays that figure would be 1,276.
Other regions have local hospitals for services, such as rehabilitation, he said, but in the ERHA there are no such hospitals and there is a need for between 500 and 700 non-acute beds.
There are currently 200 elderly patients in acute beds awaiting placement in other centres while 40 other patients requiring rehabilitation for illnesses, such as strokes, are also in acute beds.
Earlier the Minister of State for Health, Ms Mary Hanafin, told the forum that the way to increase equity in the health system was through the twin-track approach of "building up the capacity of the system and removing barriers to access to appropriate care".
The VHI's director of Finance, Mr John Looney, said that private patients "don't jump the queue; they lead the queue" for treatment.
He warned against abolishing private beds in public hospitals, which would mean turning 2,500 beds public.
Doing this he said would mean that private patients would opt out of insurance schemes and waiting lists for beds would increase dramatically.
