Questions have been raised by the Economic and Social Research Institute (ESRI) about whether or not the State's decision to pay the full cost of treatment for public patients in private hospitals through the National Treatment Purchase Fund (NTPF) is efficient.
Prof Miriam Wiley of the ESRI has said that while the NTPF has reduced waiting times for public patients by having them treated privately, questions have to be asked as to why it is paying private hospitals the full cost of procedures when an increasing number of private patients are treated in public hospitals, at times in public beds, at subsidised rates.
She expresses her concern in a new academic study published in the journal Health Economics. The study examines developments in structure, funding and delivery of the Irish health system since 1980, and notes that real cuts in health expenditure achieved in the 1980s contrast sharply with the unprecedented increase in resources devoted to the health system in the 1990s.
The number of inpatient hospital beds in the State dropped by 21 per cent from 15,111 in 1980 to 11,891 in the year 2000.
Over the same period, there was an increase in inpatient admissions, accounted for by a cut in the average length of patient stays by about one-third, the study states.
Prof Wiley says private patients continue to have better access to public hospitals than public patients and notes that the proportion of the population with a medical card has "dropped substantially" from 35.7 per cent in 1981 to 29.6 per cent in 2003.
This is accounted for, she says, by an increase in income levels but also by "the failure of the income guidelines used to determine eligibility to keep pace with the change in income levels".
Prof Wiley also said that while national health strategies over the years consistently put forward equity and efficiency as objectives, the achievement of these objectives remains an ambition rather than reality.
Furthermore, she expresses concern over the separation of responsibility for health policy and budgets under health service reforms. The Department of Health is now responsible for policy and the HSE for budgets.