Friday, January 7, 2011

Health Matters

The earliest days of the New Year sadly only act to confirm my worst fears regarding the state of the public sector in Ireland (and in particular health facilities).

Like an ever repeating broken record, we hear accounts at the beginning of January regarding the gross over-crowding of our public hospitals. Though we are told that lessons have been learnt with new plans in place to ensure that the same problems do not arise the following year, unfortunately it is always the same old story (with however matters even worse than before).

Of course the HSE will immediately point to the cuts in the health budget as a ready excuse. However the problem is really much worse than this with the truth being that we have an health service now in Ireland that in many ways has become increasingly dysfunctional.

There are many reasons for this sorry state of affairs pointing to key weaknesses in the Irish personality in dealing with administrative failure.

Firstly there is a huge lack of leadership at the political level in tackling the many powerful vested interests in the health system. The present Minister, Mary Harney represents a party that no longer exists. However far from disqualifying her from the job, the main Government party Fianna Fail has been quite happy to leave her in this important position (so that it can thereby avoid direct responsibility for any unpopular decisions taken.) So the Minister has been effectively out on a limb without enjoying the total support of her Government colleagues.

Secondly a new monolithic structure - Health Services Executive (HSE) - has been created ostensibly charged with the running of the health sector. However this has created a new problem with no one ultimately responsible for problems arising. The Minister hides behind the HSE, while the HSE is a somewhat faceless organisation with roles of responsibility deliberately blurred. So it is all designed to lead to the typical Irish problem of continual "systems failure" with conveniently no one ever directly responsible.
The HSE in any case represents a bureaucratic nightmare with far too many managerial staff who have no clear direction or purpose. Meanwhile the Government has persistently lacked the will to tackle this obvious problem of inefficiency head-on!

The health sector in Ireland has become riddled with powerful vested interests. Unions are very strong and not slow to defend their members' interests. In particular, consultants in Ireland enjoy an immensely privileged position in this system being paid substantially more than in other countries. Also it has to be said that they have proved pretty expert at defending such privileges in negotiations with weak Government!

Doctors also do very well out of the system in particular out of older patients for which they receive more than generous remuneration from the state. Also because of fears of medical litigation (and the exorbitant cost of medical insurance) rather than directly dealing with complaints, increasingly they refer patients to the hospitals for further tests thus worsening the logjam in the system.

The cost of drugs is also very high in Ireland which again reflects on the power of the pharmacies' union and also the weak bargaining position which the Government has exercised in negotiating payment with the pharmaceutical companies.

The hospitals too tend to be a law unto themselves with astronomical charges often indirectly applied to customers through the health insurance market.
So there appears to be little control exercised over health insurance costs.
Only yesterday for example the main health insurer, the VHI, announced increases in annual premiums that for some customers would be as high as 45%!

And it is not that this represents a once-off charge, for premiums have been escalating in most years by double digit increases in annual charges. And this is at a time when the economy is plunged in recession with disposable incomes for many citizens significantly reduced!

And as it stands things can only get worse. Because of the financial situation, the health budget will have to be sharply constrained for several years.

Meanwhile however, medical inflation here is escalating completely out of control. When one additionally considers that the age profile of the population is changing rapidly, with an ever higher proportion in the over 65 category, then the demands on the system will sharply increase.

In fact, given the lack of political will to enforce radical reforms and the absence of any creative response to problems that have already arisen, we are inevitably heading here in Ireland for a health crisis of truly considerable proportions.