Madam, - Constantin Gurdgiev, a protagonist of the market in health care, makes many statements supporting the co-location strategy without any evidence to back up his assertions (Head 2 Head, June 18th).
He argues that private patients are paying twice for the same care as public patients through taxation and private health insurance and, remarkably, goes on to say that this is an example of income-based discrimination that would be unimaginable in the private sector.
For an academic, Dr Gurdgiev is surprisingly deficient in his knowledge of Irish healthcare practice and should read a number of reports published in the past few years, including that by Professors Brian Nolan and Miriam Wiley of the ESRI on private practice in public hospitals and the OECD's 21-country study Income-related Inequality in the Use of Medical Care by Professor Eddy van Doorslaer.
In particular, the latter found that Ireland is the third most pro-rich of the 21 countries studied in respect of patient access to a hospital specialist and that private health insurance was the leading contributor to this inequity. These reports, taken together, confirm the reality, which most people on waiting lists in Ireland already know: if you pay cash or have private insurance, you will get quicker access to a hospital specialist, quicker investigation and treatment.
Dr Gurdgiev goes onto claim that co-location will remove obstacles to delivering higher quality services to public patients in the public hospitals. The Institute of Medicine in the US in its 2001 report Crossing the Quality Chasm defined quality in health care as care that is safe, effective, patient-centred, timely, efficient and equitable.
Will private, for-profit, co-located hospitals make healthcare in public hospitals safer, more effective, patient-centred, efficient and equitable? The only comparative research on quality of care in not-for-profit hospitals - equivalent to our public hospitals - and for-profit-hospitals comes from the US, and shows that quality of care in not-for-profit hospitals is higher than in for-profit hospitals. In addition, research from the US, the UK and Australia reveals that public hospitals are economically as efficient as for-profit hospitals and in some cases more efficient.
In a 1997 article on market-based health care in the Journal of Health Politics, Policy and Law, Robert Evans, professor of economics at the University of British Columbia in Vancouver, describes as fundamentalist those who advocate certain policies without the empirical evidence to support their position. Some of Dr Gurdgiev's arguments supporting co-location place him by right in the fundamentalist camp. - Yours, etc,
Dr JOHN BARTON, Physician/Cardiologist, Portiuncula Hospital, Ballinasloe, Co Galway.