Health according to the Irish Times

Behind bars

UNDER THE terms of the EU-IMF bailout, the Government will shave €3.8
billion from the December Budget. Much of this will have to come from
the big-spending departments of health, social welfare and education.
But already this year’s public health budget is showing strain: the
deficit to date has reached €195 million. With that overspend
increasing at a rate of €20 million a month and hospital budgets under
particular pressure, patients may feel the pain of acute cutbacks well
before 2012.

Many global health systems are under stress because people are living
longer and medical science continues to offer newer and more effective
treatments. There has been some discussion about the inevitability of
healthcare rationing in both the US and Britain. But despite a similar
mismatch between resources and demand in the Republic, there has been
little debate on the implications for the public health system here.

Rationing is defined as the controlled distribution of scarce
resources or services and is not a new concept in healthcare. It
occurs most often in times of emergency such as the increased need for
ventilators in the winter months during flu epidemics. Separately,
organ transplants are dictated by the availability, or the shortage,
of donor hearts, kidneys and lungs.

But research (including a recent Tasc report, Eliminating Health
Inequalities – A Matter of Life and Death) shows that health funding
cutbacks disproportionately affect those in the lowest socioeconomic
groups. This is especially the case when cuts take the most simplistic
route and budgets are top-sliced across the spectrum.

The health service is now facing a sharply reduced resource in the
form of a sudden drop in exchequer funding. Research by the ‘We the
Citizens’ group suggests a majority of people are against
significantly raising taxes in order to minimise the depth of health
cuts. Most of those surveyed favour spending cuts as the best way of
dealing with the massive deficit.

So without additional taxation and with the EU-IMF monitoring spending
microscopically, whither the health service? Minister for Health Dr
James Reilly’s aim to end two-tier medical care and create a universal
health system may be stillborn in the face of such swift and acute
spending cuts. The progress made by the Health Information and Quality
Authority (Hiqa) in prioritising patient safety within the HSE is also
at risk.

In the context of the billions spent on the public health system,
outdated practices and excessive pay levels persist. Inefficient use
of resources such as operating theatres and MRI scanners must be
changed. It is unacceptable to have some of the highest paid hospital
specialists in the world left idle because they cannot access unused
facilities to treat patients.

And there is a real danger that health practices and parameters
hitherto considered unsafe will be approved under a rushed “must save
money” mantra. Individual health professionals and agencies such as
Hiqa must block any attempt by the HSE to reduce services below a safe
and acceptable minimum.