Despite the heated co-location debate, little focus has been put on exactly what services will be offered. Dr Muiris Houstonprovides a guide to what patients can expect under this plan.
Most of the debate about the co-location of hospitals in the Republic has centred on the ideology of the concept. Will co-location worsen our two-tier health system? Does private healthcare threaten quality of care and equitable access?
The opposing views were well set out by Constantin Gurdgiev and Fergus O'Ferrall in the Head 2 Head column in this newspaper last week. Gurdgiev argued that co-location did not mean the privatisation of healthcare and that both public and private patients would benefit. O'Ferrall said co-location would create poorer health outcomes and raise health costs.
But what will co-location mean in practice for patients and their families?
At present, private hospitals excel at performing specific procedures, such as cataract removal or hip replacement. If you carry private health insurance, then you are likely to be treated more quickly and to high quality care in most of our private healthcare facilities.
But if you have a worsening chronic illness, such as heart failure or lung disease, then a private hospital is probably not the best place to be. Why? Because as currently structured, private hospitals generally do not have the staff or facilities to provide high quality, holistic care for acute exacerbations of chronic illnesses. They do not offer the same level of multidisciplinary care and a team approach to treatment routinely provided by our public hospitals.
Take a common clinical scenario. An otherwise healthy person in their 70s suffers a stroke. As a result, they lose most of their power on the right side of the body (hemiplegia), have difficulty speaking and can no longer walk or dress themselves.
The gold standard of care for a patient such as this involves urgent admission to a dedicated stroke unit.
Following an MRI scan, the patient will, if appropriate, be given intravenous clot-busting drugs in an attempt to dissipate the blockage that has caused the stroke.
For the first 48 hours or so, treatment will be mainly medical and nursing. But the next seven to 10 days are crucial if the person is to recover to their maximum potential.
The key to a good outcome is tightly focused, multidisciplinary care provided by a team of doctors, nurses, occupational therapists, physiotherapists and speech therapists. Arguably, it is the quality of this treatment phase that will most influence the restoration of independence to a stroke victim.
However, if they opt for treatment in a typical private hospital, then it is unlikely the patient will be offered team-based rehabilitation. Because of the way private hospitals are remunerated by health insurers, there is no incentive for private hospitals to provide a level of staffing that would enable multidisciplinary care to take place.
According to Prof Des O'Neill, consultant geriatrician at Tallaght hospital, private hospitals have difficulty accepting they have problems providing complex care.
One of the big fears of those opposed to co-location is that the new private facilities will short-change a patient such as the one we have outlined.
One consultant in a Dublin teaching hospital told The Irish Times he was concerned that co-located hospitals would not provide "seamless care at all levels".
Another spoke of his real fear that the new system will rapidly collapse, as the private facility is forced to transfer patients with treatment complications and complex medical problems to the adjacent public hospital.
Others say the new facilities will soon face the same problem as existing hospitals, with 10-15 per cent of the bed stock permanently unavailable because beds are occupied by people who no longer require acute care but who are unfit for discharge.
Sources in the Health Service Executive (HSE) do not accept the emergence of a "reverse inequity" whereby a private patient will receive inferior treatment at a co-located hospital. They say the person with an acute stroke would be assessed in a shared accident and emergency department.
When a decision to admit has been made, the patient will be asked if they wish to go to the public or private hospital. The HSE says the private hospital will be obliged to admit the patient within two hours of being requested to do so.
But will the person get the same level and quality of care in both places? Sources say the service level agreements specifically list the core services to be provided by the private facility and that they must be at a level that matches the treatment currently available in the public hospital.
They say the "cherry picking" of procedures will be expressly forbidden and that the new facilities will not be exclusive to private patients.
"Where the public hospital is full and the private facility has capacity, there will be a service level agreement in place for the private to take in the public patient," a HSE source said.
The one area that both sides agree on is that the cost of health insurance will rise substantially following the introduction of co-location to reflect the full economic cost of private healthcare. If that is indeed the case, then it is probable that fewer people will carry private health insurance. As a result, there will be more pressure on public health facilities and a reduced demand for private care. How will this affect co-location?
It will be 2011 before we can judge the impact of this seismic change in how we run the health service. And it will be the actual hospital experience of people like our stroke patient that will act as the final arbiter of the success or otherwise of the co-location model.