Those countries that provide direct access for patients to medical specialists do not have waiting list problems.
And allowing doctors to operate in both a private and public capacity contributes to delays, according to the director of the Euro Health Consumer Index, Arne Bjornberg, whose latest study has placed Ireland at the bottom of the EU list in terms of the quality of consumer healthcare.
The results of the survey make for disturbing reading. Apart from impoverished Lithuania, we fare worst in the quality of healthcare provided to citizens within Europe and we languish in 25th place. The outcome should come as a wake-up call not just to the Government and the hard-pressed taxpayer, but to the various vested interests within the healthcare system that have successfully resisted much-needed reforms for years.
As might be expected, the Tánaiste and Minister for Health, Mary Harney, has challenged the findings as being based on out-of-date statistics. Things had improved, she said. And she spoke of waiting times being cut to "about three months" for common surgery procedures under the National Treatment Purchase Fund (NTPF). It is not that simple. Nearly half of all patients spend six months or more on hospital waiting lists before they are referred to the NTPF for treatment.
It would be churlish to deny that some progress has been made. A Health Service Executive was established last year. And efforts are being made to rationalise our hospital and community services and to introduce new work practices. But reforms have been slow and halting. After three years, negotiations are continuing on a new common contract for consultants. And there is fierce disagreement over the mixing of public and private practice.
For too long, healthcare services have been structured to meet the requirements of medical practitioners, rather than consumers. The emergence of a two-tier health system, where public patients are discriminated against in favour of privately-insured clients, reflects that political failure. In spite of a succession of damning reports, little has been done.
Throwing more money at the service is no longer the answer. Measurements are urgently required to show what precisely is being delivered by hospitals and clinics in return for public funding. But the problem goes deeper than that. We score badly in this survey for infant deaths; for MRSA infections and for poor medical outcomes to operations. Waiting times are excessive; patient rights to information are limited and there is a low level of polio vaccination among children. The existing health system, dominated by service providers, has failed. The political challenge is to move the needs of the consumer centre stage.