Speakers at a forum on healthcare reform at the annual meeting of the Irish College of General Practitioners in Galway at the weekend came out strongly in favour of a universal health system that would ensure equity of access to healthcare.
Ms Maev-Ann Wren, the economist, journalist and author, in a paper titled: "Patients and Doctors in an Unhealthy State", said the substantial drop in the percentage of the population entitled to a medical care meant there were now "really serious barriers to healthcare " in the Republic.
She told GPs that because the cost of a single visit to a general practitioner and a subsequent pharmacy bill represented 40 per cent of the weekly income of an individual just above the eligibility limit for a medical card, "there are large number of people, (who need medical care), whom you are not seeing."
Referring to statistics which show that 70 per cent of third-level graduates have private health insurance, compared with just 21 per cent of unskilled manual workers, Ms Wren said: "this shows that there is not just a twin track access, but a class-based access to healthcare here".
Further evidence of inequality in access to hospital care (from a 1999 ESRI report) is that while 22 per cent of uninsured patients has to wait over a year for hospital treatment, no one with private health insurance endured a similar wait.
Emphasising that we still have an underfunded health system in the Republic, she said that a recent OECD analysis of Irish figures "made clear that 25 per cent of what we call health spending is actually social spending".
On the proposed Hanly reform of the hospital system, she asked, "How will it work without investment in the primary care strategy?" And in reference to the new Health Service Executive (HSE), Ms Wren questioned who controlled it and what values will inform it. She also asked if the HSE had any role in the promotion of public health.
In a reference to the affordability of free GP care in the Republic, she estimated that free GP services could be introduced at a total cost of €912 million, representing an additional tax or insurance burden of €163 per capita. "My point is, of course we can have affordable GP care under this model. I would argue that this is a societal choice and not an issue of affordability", she told the meeting.
Dr Garry Courtney, consultant physician and clinical director of St Luke's Hospital in Kilkenny, called for improved GP access to hospital services. "GPs must have access to informal consultation with hospital consultants."
Pointing out that, in general, what the health system does not do well at present is get people in and out of hospital, he said that through the setting up of a medical assessment unit and other initiatives, St Luke's hospital processes most of its patients within two to three hours. "The result is order instead of total chaos and improved patient satisfaction."
Dr Richard Brennan, outgoing chairman of the ICGP, said the role of the family doctor is to provide an integrated health service in the community. "The solution to the provision of 24-hour cover in hospitals must primarily lie within the hospital sector. Our commitment is to the community and we must state that" he said.
Speaking from the floor, Lucan GP Dr Tony Feeney said it was important that the ICGP got out the message that " it did not speak with the same voice as the IHCA (Irish Hospital Consultants' Association). We are not interested in greed or arrogance. Large numbers of GPs are in favour of a universal health care system."