Madam, - My referral of the co-location agreement between the HSE and the Beacon Medical Group to the Competition Authority has been criticised by Michael Cullen, Beacon's CEO, who describes me as "obviously politically motivated" (The Irish Times, August 26th). Of course I am. Politics has profound effects on health outcomes. Democracy, wealth-distributive ideologies and the availability of universal healthcare heave all been shown to be associated with lower infant mortality and longer life expectancy.
Political actions - such as Mary Harney's almost forgotten but very successful measures to rid Dublin of smog almost two decades ago - can greatly improve citizens' quality of life. Other recent evidence-based initiatives, such as the plan by Ms Harney and the HSE to rationalise hospitals and invest in primary care, can be expected to yield good results. But some political interventions lead to bad results.
Mr Cullen is "obviously not politically motivated" — far from it. After all, does anyone stand to gain more financially from this process than Mr Cullen does? Yet he seems to expect us all to believe that the acute medical welfare of some 200,000 people in the Mid-West who are covered by private insurance can be safely entrusted to his crew of investors and that no one will say: "Wait a minute. Who are these investors and what is their background and record?"
Does Mr Cullen believe that the custom of these 200,000 citizens has become his by right as a result of the co-location agreement? And does the Government think it can hive us off to Mr Cullen and his cronies and get away with it? Mr Cullen says there are many studies that discount my claims that for-profit providers, like himself, provide a poorer care at greater cost and with higher mortality.
I have been unable to find any such material in the medical literature.
Among the material I have submitted to the Competition Authority are papers from first-rate peer-review medical journals, such as the New England Journal of Medicine, the Journal of the American Medical Association and the Canadian Medical Association Journal.
In high quality studies and meticulously performed meta-analyses involving very large numbers of patients and hospitals, it has been shown that mortality is 2 per cent higher in for-profit hospitals (a study involving some 36 million patients); that mortality is over 8 per cent higher in for-profit dialysis units - an excess of some 2,500 annual deaths in the US; that payments to for-profit hospitals are 19 per cent higher (350,000 patients); that Medicare payments are higher in areas of the US served by for-profit hospitals; that five different measures of quality of care for three acute medical conditions were consistently worse in for-profit hospitals (a study involving some 4,000 hospitals); and that for-profit hospitals spend less on nurses and more on managers.
Thanks to its reliance on for-profit hospitals, the US is now spending 17 per cent of its GDP on health and getting consistently mediocre results. This expenditure is expected to rise to a bankrupting 20 per cent in the near future. But very great fortunes are being made by CEOs and investors in this massive industry.
There is a dire need for investment in many of the State's major hospitals. To address this urgently and pragmatically, the best thing that could happen now is that the co-located hospitals would be built swiftly and then be expropriated by the State, renouncing any previous agreements in the national interest. Neither difficult nor expensive - legislation is a marvelous tool.
I expect that the Competition Authority might reach a similar conclusion. The for-profit barbarians may be at the gate, but it's not too late to send them packing. - Yours, etc,
Dr GERRY BURKE,
Riverside Clinic,
Limerick.