1/ So maybe the hard question!
We seem nowadays to be binary. It’s all in or all out. And in case there is any doubt, I absolutely want there to be better public system to treat all people the way they deserve, and for me that starts with the patient sitting with me in the room.
We seem nowadays to be binary. It’s all in or all out. And in case there is any doubt, I absolutely want there to be better public system to treat all people the way they deserve, and for me that starts with the patient sitting with me in the room.
2/ So let’s ask the question
1. Is private medicine the reason that patients on public waiting lists have to wait so long ?
2. Did the person having an operation to remove a bowel cancer, a breast cancer, in a private hospital jump ahead of the queue on the public waiting list
1. Is private medicine the reason that patients on public waiting lists have to wait so long ?
2. Did the person having an operation to remove a bowel cancer, a breast cancer, in a private hospital jump ahead of the queue on the public waiting list
3/Private medicine only exists because people are unable to access clinics/diagnostic test/ operations as quickly as they would like to or need to in the public system.
4/ Is it possibly to perhaps look at it another way. People pay taxes, those taxes are used to fund the Public Health Service. 52% of people then pay again for health insurance. Why do they pay for it? Because they want to ensure they can access their health needs quickly.
5/ They feel, rightly or wrongly, that they can’t get access in the public system. So they pay another “tax” as such for private insurance. It should be stated that every citizen whether they pay health insurance or not has an equal right to access the public health system.
6/ How can anger be directed at private patients in public hospitals? If they choose to be in a queue for a procedure on a public waiting list, then they have every right to be on that list. Their insurance status does not change their place on the public queue.
7/ Let’s now consider the scenario that a surgical waiting list has 50 people on it. There are two outcomes
8/ The patient with private insurance chooses to have her cancer surgery in the public system. She has her surgery based on need, and when admitted, she is asked the hospital will she sign her insurance forms so that the hospital can claim fees for her operation/inpatient stay.
9/ This does not change her position on the public queue, but allows the hospital to get added income from her health insurer. Hospital budgets have for decades always run out before the end of the year, so any extra income to the budget that the hospital can get must be welcome.
10/ The patient’s surgeon is conscious that he/she has two theatre sessions per week in the public hospital and can probably do 7-8 operations in that theatre time allotted. The waiting list grows.
11/ The surgeons main skill set is operating, surgeries that can remove cancers, replace hips and knees in people who can no longer walk or are in chronic pain, surgeries to restore someone’s sight. So the surgeon needs access to theatre.
12/The surgeon would love to perform more operations if he/she could in their working week. No doctor wants a patient waiting on a waiting list. But theatre space is shared between all the surgical subspecialties.
13/Every surgeon and specialty just wants to do the best for their patient, they want to help them, to remove the cancer, to restore blood flow to the heart or the leg, to take away the brain tumour, to reconstruct a breast for a women who has undergone bilateral mastectomies.
14/Public or private does not matter. It’s about the patient
15/ So our patient can use her insurance to take herself off the public waiting list. The waiting list of 50 is now 25, if the 50% of people on the list with insurance decide to have their operations elsewhere.
16/ The surgeon as mentioned above can do more surgeries in his/her working week if more theatre space was available. So the operation goes ahead in the private sector.
17/ So the issue is mostly about capacity in our public sector.
18/ So if 2.2 million people pay health insurance, and let’s consider an average figure of €1000 per person, that’s over 2 billion euro a year paid by citizens.
19/ Currently over 800 million is paid out by insurance companies to the public system per year, which adds to the public purse, 800 million on top of what our taxes have already put in
20/So for a public only health system, we need invest in it. Let’s build more capacity in the system, let’s spend the 5-10 billion currently required just to replace the equipment (CT scanners, MRI, theatre equipment, IT, etc)
21/Now we need to also spend on building more capacity in the system, more beds, new hospital buildings which are fit for purpose (replace the buildings which are hundreds of years old).
22/ Now let’s get the increased staff needed. We have the lowest number of specialists per head of population in Europe. We have a doctor and nursing crisis for many years.
23/ We have GP practices working every day of the week often struggling to keep afloat based on recent cuts to funding. You see, this all costs massive amounts. And you need to pay for that through taxation.
24/So if I see a patient in a public clinic and I feel they need a CT scan or MRI, I know they will have to wait months and months to have that done in the public system. If they have private insurance, they can access it much quicker
25/There are more privately run CT and MRI scanners than there are public scanners. My duty is to my patient, I have no other motive. So I send them to have it done using their insurance and the patient is the benefactor - diagnosis, treatment plan, quickly and efficiently
