Waiting till Godot knows when

The surprise at the inaccuracy of waiting lists is, well a surprise. Whatever about public waiting times, try asking the HSE, or any public or voluntary hospital, what the waiting times are for private patients. You will not get an answer. Frame the questions carefully – the answer is only as informative as the crafting of the question.

Ask HIQA. Ditto. They will tell you their assumption is that the information they get from the HSE is inclusive, complete, etc, blah blah. Although HIQA has covered waiting times in its reports, it has never, ever, sought to look at differences in access, as between public and private. Yet, one can infer that HIQA does regard access as a rather important part of “quality” (no doubt a mid-Mediterranean Syrian refugee would agree, as would someone years “waiting” in “direct provision” here).

Public and voluntary hospitals are staffed by salaried public servants. Uniquely amongst these, consultants – some, not all – collect fees from private patients, and these have separate access, almost certainly quicker. The dogs in the street know this, but given the difference isn’t measured, we don’t “know” it as fact, and so have no need to acknowledge it, far less to address it.

The discipline of Public Health Medicine has a lot to answer for too, unfortunately. 

When Departments of Public Health were set up in the old Health Boards, their Heads reported to the CEO’s. Public health research into, or reports on whether or not possession of private health insurance is an independent determinant of health, or highlighting public/private differences in access to public hospitals, wouldn’t have been welcome, and didn’t happen. At one stage, a TD, at a health board meeting, asked its CEO about this matter. The response was that this was a private matter between consultants and their private patients. There was even an expenditure of money on legal advice to defend this position (Bernard Allen TD, Sean Hurley CEO Southern Health Board). That’s about as close as it got.
One would think that unions, so vocal in defence of the ordinary citizen, would have addressed this. No; in fact, many run group VHI and other schemes for their members.

We, the half of the population with private health insurance, are all complicit. We know full well that access to specialist care, either outpatient or inpatient, would take an unknowably long time were we medical card holders, whereas we will be “seen”, usually promptly, as a result of our “serum VHI” levels. And we shrug at any talk about universal healthcare; it might cost more, and drag us down, so let’s just leave it. Rather be looked after by a named Doctor in their “rooms” than examined by God-knows-who in “outpatients”. Bit of a conversation-stopper when you’re not sure who you’re talking too, if you know what I mean. Enough said.

People often buy private health insurance out of fear (Nolan & Wiley). Fear that access to hospital care will be otherwise dangerously delayed. So, poor public confidence in public healthcare is a good thing for private medicine. Utterances over the years, most particularly by the IHCA, reinforce this perception. Public bad, private good, if it wasn’t for us, sure it would be even worse.

No, it’s not the consultants’ fault; they had a contract to die for and why wouldn’t they defend it, despite its perverse economic disincentives wrt public care?

Discussions about all of this, when they occur – in Hawkins House, on TV, at conferences – occur between people virtually all of whom have private health insurance. It’s like men discussing women’s health.

The two-tier public hospital system we have is an international curiosity. Although we like to think of ourselves as amongst the more advanced European nations – those with the enlightened social programmes, and a well-informed citizenry satisfied to fund them – we operate a hospital system that Trump and Co would approve of heartily. Perhaps that is what Irish people want. I wouldn’t know. We’ve never been asked. And anyway, I’ve no solid data on any differences there are in access to public hospital care, between public and private patients. Ignorance is bliss.

Meanwhile, trolleys in A&E? – Cowardly politicians, squirrel-herding managers, wonderful doctors and nurses, more money needed etc – the usual banter and badinage. This too will pass, until the next time. Every Minister for Health is allowed to set whatever policy he/she wants for the people of Ireland, so toxic and Black-Hawk-Down is the portfolio. The time before last, the crowd that “got in” had promised “Universal Health Insurance” – well their prospective Minister had anyway. But that was then, this is now. That was before, this is since. The weak wait a long time in politics.

Healthcare heroes needed; apply within.