Removing private care from public hospitals could impact upon the taxpayer and the care they receive, says the CEO of Cork University Hospital.
Tony McNamara warned that the proposal to incrementally remove private practice from public hospitals, as put forth in the Slaintecare report, could favour those who can pay. He said this does not reflect the values of the Irish people.
Mr McNamara said the proposal needs to be “very carefully considered” to avoid unintended consequences, which could destabilise the Irish hospital system.
“There are many reasons as to why the answer is not to take private practice out of public hospitals as a means of addressing these problems of access and accountability.
“In the first instance, we must decide on what type of hospital system we want in Ireland,” added Mr McNamara.
He compared the system put forward in Slaintecare to the health system in the US, “that is largely (and increasingly) based on an ability to pay. Irish people are not innately discriminatory and I do not believe that implementing a model of access to hospitals that will discriminate on the basis of capacity to pay, such as is proposed in Slaintecare, reflects the values of Irish people,” said Mr McNamara.
The capacity to pay for speedier access is an injustice, he said, that can be addressed with improved implementation of the provisions of the consultant contract, greater transparency, the creation of common waiting lists for specialities, and increased accountability in hospitals.
The access that non-insured patients get to consultants, because of the mixed public/private system that we have in public hospitals in Ireland, is key, according to Mr McNamara.
He said that, at present, the Irish hospital system recruits the very best consultant staff, but that there is “a very real probability that, over time, a restriction to generate private income in public hospitals will result in the best doctors migrating to private hospitals.
“That would be a serious impediment to the capacity of the Irish hospital system to achieve its potential through international collaborations for clinical trials, research, and the delivery of high-quality, safe care, as measured against peer hospitals internationally.
“There is also the practical issue of the cost of such a decision to the taxpayer,” added Mr McNamara.
“Public hospitals in Ireland currently generate around €600m annually in income from private practice and, obviously, this level of funding will need to be compensated by the exchequer.”
Mr McNamara also warned that, in the wake of such a removal of services, private hospitals could selectively decide to cater for the more lucrative specialists.
He said that, in such circumstances, the government would be left to pick up the slack on less-profitable services, “a task that will be made all the more difficult when it will be ever more difficult to recruit consultants to hospitals that will not support private practice.”
These are critically important issues that warrant reflection and discussion, before the State embarks on a radical change in policy that has the potential to adversely impact on the delivery of hospital services, warned Mr McNamara.
The Slaintecare Working Group could shape the hospital system in Ireland for decades to come, he added.