Sir, - The recent St Vincent de Paul report and your Editorial (April 14th), are a further indictment of the state of our health services. The report is a powerful document that illustrates that income inequality continues to be associated with poorer health outcome.
Your Editorial highlights a situation with regard to general practitioner services, which GPs, through their representative organisations, have identified and brought to the attention of the Minister and the Department of Health, ie., that current income-limit thresholds with regard to medical card elegibility are unrealistic, and need urgent readjustment.
A large number of those most in need, including those on the minimum wage, are excluded from the services to which they should be entitled. Social conscience does not appear to be part of this Government's thinking, and there appears to be collective denial that poverty exists.
People on low incomes have a low-priority rating with regard to elegibility for medical cards and of even more concern is the low priority in addressing their actual health needs. The "inverse-care law" applies - those most in need have the least access to the services they most need.
The common perception is that extra funding of the hospital services and the provision of extra consultants and beds is the answer. While there is need for reform of the hospital services, this should not be done without reform and investment in primary care, including GP services. The long-term health needs of low-income groups, including improvement in their morbidity and mortality rates, must be addressed in the primary-care context.
The medical card scheme, since its inception, has made no provision for preventative health care, and in the past it was actively discouraged. The lack of any general practice based preventative programmes in cardiovascular disease and cancer screening over the last 30 years, has contributed to our current appalling and unacceptable rates for these diseases.
International evidence shows that countries with strong primary-care systems have lower overall health-care costs and generally healthier populations and more primary-care physician availability, while not eliminating, does reduce the adverse effects of social inequality.
In addressing the chaos of our health services, with their inequities and inequalities, we must ensure that primary-care services, including general practice, are properly funded. There is urgent need for proper investment by government in general practice infrastructure and personnel nationally.
It is essential that those most in need, have access to a quality GP service, with prevention and treatment of illness in the most appropriate setting. The concentration of investment in high cost hospital expansion, technology and consultant numbers will not solve the health crisis, but may in fact exacerbate the problem.
The health-care needs of the poor, the disadvantaged, the handicapped, and the elderly must be addressed and met in a community setting, where possible. Properly targeted investment in primary care and in GP services has the potential to improve the overall health of the nation, but especially the health of the poorer and weaker sections of our society in the long term. It also has the potential to reduce the demand on hospital services, both in the short and in the long term.
The St Vincent De Paul report highlights the failures of our health-care system in a very graphic manner. It is up to the Minister and his officials to respond in a rapid and imaginative way, and demonstrate that caring and social conscience are still part of our tradition. - Yours, etc.,
Dr R. Brennan GP, Ballyhale, Co Kilkenny.