Madam, - Under the co-location plan, a number of 100 to 150-bed commercially independent private hospitals will be built on the grounds of our larger public hospitals. The intention is that beds in the public hospital will be "freed up" because private patients will no longer require public hospital care.
But it is unreasonable to expect a 150-bed private hospital to duplicate the functions of a large public hospital. The staff levels required would make it uneconomic even if health insurance rises significantly. So it's not going to happen. Large numbers of patients with health insurance will still need admission to the public hospital, depending on the complexity of their illnesses and the level of care required.
That is not a problem for the patients, as we all have a statutory right to public hospital care. But it creates a financial problem for the public hospitals, as under the co-location scheme it appears they will lose the right to charge for treating insured patients. This will be a welcome bonus to the health insurers but means a significant loss of income for the hospitals.
Meanwhile, private hospitals will have unused capacity and will be looking for other revenue streams. As public hospitals will continue to be over-burdened, the obvious answer is a contract whereby private hospitals treat non-insured cases which are suitable for the services they provide.
So the likely outcome, for clinical and commercial reasons, is that when our illness is of low to medium complexity, we can expect to be treated in the comfort of the private hospital. When our illness is of medium to high complexity, we will remain in the public hospital, whether or not we have health insurance.
This is a sensible outcome from the clinical point of view. But what about the money? Unfortunately, when public money is spent in the private sector, the record on value for money is not good.
A useful example is the National Treatment Purchase Fund, which has a budget equivalent to 2 per cent of the National Hospitals Office to spend in private hospitals, but which has difficulty achieving treatment for 2 per cent of patients. Even though the fund is careful to select less complex patients, its 2006 annual report shows that it managed to buy only 17,000 planned tests or treatments and treat a small number of out-patients (7,000) for €74 million.
If any of our public general hospitals produced a detailed annual report, we would see that a similar amount of money goes much further: €74 million spent in a public hospital would yield larger numbers of tests and treatments for the full range of cases (planned and emergency, straightforward and complex) and for much larger numbers of out-patients, as well as offering the full service of a general hospital.
It is too easy to see the "value" of private hospital care, but only the "cost" of public hospital care. - Yours, etc,
Dr CHRISTINE O'MALLEY, Consultant Geriatrician, Nenagh General Hospital, Nenagh, Co Tipperary.