Madam, - I read with great interest of the plans to increase the bed capacity of public hospitals by 1,000 in the next five years. This plan, announced by Minister for Health Mary Harney, would create only a third of the capacity urgently needed in the acute hospital system.
It appears also that the 52 per cent of the population who have opted for private health cover are now going to be squeezed out of the public hospitals. Let us not forget that these hospitals are funded through the general taxation and health levies of this section of the population as well as the rest. If more than half the population have health insurance and have opted to be private patients, how can we say that a bed capacity of 2,500 is adequate for their clinical needs?
This plan alone cannot deal with the chronic overcrowding in our hospitals. The health strategy launched in 2001 by the current coalition clearly identified a need for 3,000 extra beds over 10 years. Almost four years later, only 400-plus beds have been delivered in real terms.
More than 71 per cent of admissions to our acute hospitals are emergencies and neither consultants nor hospital management have any control over what eligibility these patients have. Both public and private patients receive care of very high standard from all health professionals under the direct supervision and leadership of consultants in the hospitals.
It is alarming to note that in near future private patients or, by default, their insurers would be charged 40 per cent extra to cover the full economic cost of their treatment. This undoubtedly would lead to increases in the premiums for health insurance by even more than 40 per cent.
The inevitable result would be a significant number of current health insurance subscribers opting out, so the public health system would have to look after their health needs as well. The financial implications of this would be enormous for the already stretched health service.
What we need is a balanced and careful approach for the expansion and development of a health service that ideally should be based on not-for-profit investment and should be able to deliver a high-quality and efficient service.
The current system by which more than 52 per cent of the population pay for their healthcare through private insurance - albeit only 60 per cent of the economic cost - is better than a system in which the taxpayer may have to pick up the full bill for the care of those who would be unable to afford higher premiums. - Yours, etc,
Dr ASAM ISHTIAQ, President, Irish Medical Organisation, Dublin 2.
Madam, - Your Medical Correspondent, Dr Muiris Houston, asserts that the shortage of acute hospital beds "was created by. . .Barry Desmond and Rory O'Hanlon in the cash-strapped 1980s" (Opinion, July 15th). This is a misrepresentation of my record as Minister for Health from 1982 to 1987.
The most comprehensive analysis of such beds is in the National Review of Acute Bed Capacity published by the Department of Health and Children in 2002. There were 17,582 beds in 1982 and 16,878 in 1986. The reduction of 704, or 4 per cent, arose primarily from my implementation of a necessary policy of rationalisation of acute services in Dublin, Cork and elsewhere. For example, with population moving to outer Dublin (i.e. Tallaght) the smaller inner-city hospitals were closed.
I was pilloried by Fianna Fáil for implementing this necessary policy, which explains the relatively minor bed reduction over these four years.
In February 1987, I and my Labour colleagues resigned from the Cabinet, having refused to agree very big cuts in hospital services which were also stridently demanded by the PDs, including Mary Harney. These were the years when Dick Spring and I were derided when we spoke of rampant tax evasion and offshore tax avoidance.
All changed immediately after the 1987 election. Ray MacSharry, Minister for Finance, and my successor, Rory O'Hanlon, slashed 3,072 acute beds from the system, leaving 13,806 in 1991, a reduction of 18 per cent.
Whatever about the "cash-strapped 1980s", Mary Harney now has no apologia. She is in thrall to some seriously right-wing health economists. Her ambition is to create an entirely privatised Irish health service on the Boston model. Hence the intent to privatise the VHI and the running-down of its €300 million reserves in anticipation.
Hence the U-turns on risk equalisation in health insurance and the effective ditching of community rating. Hence the proposed transfer of €140 million income from the private beds now in public hospitals to the proposed for-profit private hospitals to be built on public lands.
And Ms Harney's ideological soul mate, before his enforced departure to Brussels, provided a future massive tax rental subsidy offset of €190,000 for each new private bed to these private hospital investors!
Your Medical Correspondent will have much to analyse when, in this decade, health insurance premiums and public bed charges double, all in the name of "competition". And the Taoiseach cannot claim that he only signed "a blank cheque". - Yours, etc,
BARRY DESMOND, Taney Avenue, Dublin 14.