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Light at the end of the health service?

6.04.2005

Moore McDowell was righting this morning regarding the health service and the absolute nightmare of a state that it finds itself in. I agree however with his fundamental point that things are so bad now that they present an opportunity for genuine reform and overhaul of the Health Service, though I reckon that we may differ on the form a revised service may take. The main crux of the problem is the complex and often frustrating funding structure that currently exists in the service. The current proposal by both McDowell and the Labour party is to reform the system using a national health insurance.
It is here that the issue gets really tasty, national health insurance is a very interesting idea; instead of the health boards allocating funding as it sees fit, the money follows the patient. This brings the whole choice theory into play. The idea behind choice theory is to empower a consumer against a sluggish and immobile service by offering them the option of exit, where a consumer threatens to exit from the service the threat is used to create improvements in the service that might not otherwise have been made. This boiling down of patients to consumers of health care may cut no ice with a cancer patient but it’s a big hit with the big wigs in Leinster House. Anyhow by abolishing the current funding structure, one can create a liquid and responsive health service that can see all patients as equals. The reason for this is that the distinction between public and private patient is abolished. The hospital or primary care provider receives the same amount of money no matter who the patient is or what status they have. It’s a wonderful sounding system and any progressive mind is surely going to be behind the labour policy of providing the poorest 50% of our population with free insurance and subsidising the next 10% while the richest 40% are allowed to pay their own way. It seems frightfully modern and progressive in its aspect. The poor and the rich all have supreme mobility to go and seek the best service from the best provider and providers only earn by making all patients better not just the lucrative ones.
It is however also a slight bit worrying, for it is not just the patient that must be considered in this equation. The introduction of private health care providers is the obvious tag on to any such reform of the state health system. Many would advocate the power of the private sector to deliver because it must return a profit. However when it comes to peoples health I am a firm believer that profit is and must be secondary to people’s health and the standard of their care. In a competitive environment than would be heralded by a new health service we must be careful to require government to guarantee a minimum level of provision for all population. This means that less profitable country hospitals must have the chance to remain open as the hinterland requires them. There must be guarantees regarding the status of A&E and above all the state must be able to avoid out sourcing and wage exploitation by private health care providers. In a social democracy one must be aware of the power of regulation to do well and in such a situation as the provision of health there is need for much oversight and regulation.
Trade unions should be encouraged in order to offset corporate drives to cut costs in the extreme and increase profitability. We do not need cuts in costs or corners in any health service. Therefore I believe a special labour commission should be established in order to settle special health labour disputes and be furnished with an inspectorate to ensure labour standards are met by outside providers. These standards extend to hospital cleaners also as these are the front line of any fight against MRSA and its ilk.
While many companies may accuse the government of stifling initiative etc, these arguments should be canned, peoples health is no place to become an entrepreneur.
The need for equity and fairness in out system is clear, it seems that a national insurance should be an option to follow but in pursuing this dangerous game of including business in the public realm a strong line must be maintained against the interests of profit. A strong hand and stronger guiding principles are required to ensure any reformed health service doesn’t fall to vested interests as this one does.
Not alone this but when money is no longer tied to geographical certainty some areas of the country are bound to fall behind, it is the job of a progressive to proactively seek equity and fairness rather than blindly trusting market forces to ensure we receive what we deserve.
Red Rover

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