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Ireland's health system is broken, we need an NHS model like the UK

Private for-profit health care systems are both more costly and provide lower quality care than public systems, writes Julien Mercille.

Julien Mercille Associate professor, UCD

OPINION POLLS SHOW that free universal health care is the number one priority for Irish people. Yet, the government’s ongoing reforms are paving the way for privatisation of our health care system, which will make it more expensive, of lower quality, and more unequal in access. Instead, we should call for an Irish NHS based on the UK model.

When governments wish to privatise a public service, they often start by cutting public funding to that service. This leads to bad performance, as lack of resources and over-extended staff cannot keep up. We then hear that the public sector is bloated and inefficient and that the efficient private sector offers solutions, opening the door to privatisation.

Indeed, under austerity, public spending on health has been reduced by 12% since 2009. Staff numbers have fallen by 14,000, or 13% of total staffing since 2007.

No wonder that things are getting chaotic and that we have a trolley crisis and unacceptable waiting times.

Fine Gael and Minister for Health Leo Varadkar have proposed market-based reforms and they are implementing them. The explicit objective is to push the system closer toward a private enterprise model. Our public hospitals will be much more reliant on the market to raise investment funds and will be penalised if they don’t reach certain financial targets. Money will come first, and quality second.

We are told that reforms will bring “efficiency”, “patient choice”, “greater autonomy for our medical professionals”, “cost saving”, etc.

This is not true.

On the contrary, it is well established that private for-profit health care systems are both more costly and provide lower quality care than public systems, in addition to being more unequal in access.

The editor of The Lancet, the world’s leading medical journal, blasted market-based reforms in Britain, putting it bluntly: “People will die because of the Government’s decision to focus on [market] competition rather than quality in health care”.

Our government says that public hospitals will remain publicly owned.

For now, this is true, but the ongoing changes set the stage for privatisation down the line.

Indeed, Varadkar himself recently admitted this when he said:

Where hospitals consistently under perform in terms of clinical outcomes, patient experience and financial management, it should be open to the provider to transfer management of the hospital for a period of time to a private provider by means of a concession or management contract.

The Irish Medical Organisation (IMO), which represents doctors in Ireland, strongly criticised Varadkar and stated that his idea that profit-minded private businesses could take over public hospitals was “grossly insensitive and ill conceived”— it “will downgrade public service and pave the way for privatisation of our essential health services”. The IMO said that Varadkar was trying “to avoid responsibility for the consequences of years of austerity in the health services”.

The IMO recalled that for-profit medicine “has been a disaster in other countries”, most evidently in the US.

The US has by far the most privatised system in the world. The two graphs show that it is twice as expensive as other developed countries’ systems which are largely public.

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Why are for-profit systems so expensive? One reason is that they need to generate profits and pay bonuses for executives, taking funds away from care. Another is bureaucratic waste. Privatised systems involve a lot of paperwork to assess insurance claims, to code and price hospital services, to record all transactions taking place in the market, and so on. In Ireland, there are now over 400 insurance plans available. This makes it extremely complicated to manage and involves armies of private bureaucrats to process.

The US has the highest administration expenditures among developed countries, accounting for 25% of total hospital spending, compared to 12% in Canada and 16% in England (which have public systems). The US would save $150 billion a year if it reduced its administrative expenses to Canada’s level.

If the US had better health outcomes, this could be justified, but it’s the opposite. For example, life expectancy in the US is only 78.7 years whereas all other developed countries are above 80.0 years. Also, infant mortality is at 6.1 deaths per 1,000 live births in the US, the worst among developed countries.

In for-profit systems, quality of care is compromised because doctors may be under pressure “to refer patients for particular procedures that are more profitable” or “to discharge patients early to meet activity levels and reduce their length of stay. The risk of readmission and even death in these cases is high”, stated the IMO. In short, prioritising the bottom line over health is a recipe for disaster.

We’re lucky to have a great model next door: Britain’s NHS, which has been ranked recently as the world’s best system by the renowned Commonwealth Fund. Health care is provided by the government and financed by the state through general taxation. The private insurance market is very small. Irish people deserve no less than that.

Julien Mercille is a lecturer at University College Dublin. 

Read: Is Leo feeling the effects of ‘poison chalice’ he was handed?>

About the author:

Julien Mercille  / Associate professor, UCD

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