Posted on August 1, 2006

Shorter waiting times in Ireland's public system


Private not much quicker for treatment
By Susan Mitchell and Nicole Matthews

The Sunday Business Post (Ireland)
July 30, 2006

Hospital consultants have questioned the benefits of paying for private health insurance. Some claim going private does not necessarily ensure a fast-track to the operating table and that chronically ill patients are often better off in the public system.

Citing the reduction in procedure waiting times under the National Treatment Purchase Fund (NTPF), the private sector’s inability to treat patients and the escalating cost of health insurance, they believe the benefits of having private health insurance are diminishing.

Consultant neurologist Dr. Orla Hardiman, director of neurology at Beaumont, and a medical adviser to the Neurological Alliance of Ireland, said that in some instances her public waiting list is actually shorter than her private waiting list.

“For some neurological conditions people can actually be seen more quickly in the public sector. Most neurologists have small private practices, so the number of private patients we can take is quite small. If someone has a problem that requires ongoing management and multi-disciplinary care they are better off in the public system,” she said.

“There are times when the private sector can offer quicker access for patients looking for specific procedures, but the benefits are not as clear-cut for chronically ill patients. There is no huge advantage in these patients having private cover as the services are not available in private hospitals,” said Hardiman.

Other consultants have had similar experiences. Professor John Crown, consultant oncologist at St Vincent’s Hospital in Dublin, said of patients with cancer: “We have had a much bigger waiting list for patients with private health insurance trying to get chemotherapy in St Vincent’s Private Hospital.

“That has been the case for a number of years. The public waiting list has been a lot shorter.”

Crown said he and his colleagues often move private patients who need urgent treatment into the public system.

In a recent interview with the Irish Medical News, Brendan Healy, orthopaedic surgeon in Sligo and an elected member of the Medical Council, said the NTPF was getting patients off the lengthy outpatient lists.

Established in 2002 to try to tackle long-term waiting lists for surgical procedures, the NTPF finds spare capacity in the system - both public and private - and uses it to arrange operations for patients who have been waiting three months or more before contacting the fund.

Healy said patients were being treated for free in the same private beds as fee-paying insured patients. He stressed that he was not suggesting people shelve their private health insurance, but that they consider their cover needs.

“I’m wondering should people bother having insurance, and having double taxation, unless they have a fast-track.

“Because if you are waiting for three months, you can get into the same hospital under the NTPF and end up in a bed alongside somebody who has paid thousands in extra taxes (subscriptions),” he said.


By Don McCanne, M.D.

The policy lesson is that directing efforts to simple queue management will reduce waiting times, whether in the public or private sector. Those who state that excessive queues are inevitable in publicly funded programs and are eliminated with private funding are flat-out wrong.

Effective queue management is dependent on the diligence of the stewards of the health care system and not on whether the source of funding is private or public.

The infrastructure of a single payer system for the United States would include queue management and is ideally suited to do so, especially when compared to our current fragmented system of funding care. You should emphatically reject the claim of those who state that excessive delays are inevitable in a single payer system and non-existent in the privately insured market.