Why can people on Irish public waiting lists choose to be treated in private hospitals in any EU country – except here?
Opinion Article published in the Sunday Business Post, 17 July 2017
The news last week that Irish hospital waiting lists had hit yet another all-time high, garnered relatively little media and political scrutiny beyond the reporting of the continuing upward trend in the monthly figures.
Are we in danger of apathy simply because of the sheer scale of the problem? Are we becoming immune to the fact that almost 1 in 8 people in Ireland (570,000) currently await some form of treatment? Is it too much to comprehend that an additional 14,000 Irish patients joined the queue since March this year alone?
It may surprise readers to learn that there is an antidote – a ready-made solution that exists right on our own doorsteps. There is a network of 19 private hospitals dotted throughout the country, all of whom if only given the word could be making substantial in-roads into these waiting list numbers.
Sadly, the opportunity to work with Ireland’s high quality private hospitals is being virtually ignored by Government, though the decision by Minister Harris to reactivate the National Treatment Purchase Fund and make a start this year on treating some of the longest waiters is one encouraging sign for the future.
Meanwhile, we have the perverse situation prevailing where waiting patients are being urged by the State to seek treatment abroad but not here.
As this newspaper recently highlighted, the HSE is spending increasing amounts of money under the Cross Border Directive treating public patients elsewhere in the EU. Bizarrely, the only private hospitals in Europe where patients are not entitled to be treated are those in Ireland. You can choose Milan or Munich, Bristol or Budapest but if you go to any private hospital across Ireland you won’t be refunded by the HSE.
Minister Harris told the recent conference of the Private Hospitals Association we should all wear the green jersey for healthcare in Ireland. While our members chorused agreement, the actions and policies of his Department constantly strike a discordant note and in fact point to the opposite. The Minister’s green jersey is firmly snagged on a rusty nail of ideological opposition from within Hawkins House – opposition to contracting with private providers, despite the very real opportunity to resolve this country’s waiting list epidemic.
Our members are simply seeking parity. With the Cross Border Treatment Directive, the HSE will only refund the bills from a private or public hospital in an EU country up to the cost of doing the procedure in a public hospital in Ireland. Why not simply apply the same rule within Ireland?
Member states are not required by the EU to apply the Cross-Border Directive in their home country but neither do they forbid it – and you would think the spirit of the Directive is that each member state would exhaust all local treatment opportunities before sending patients abroad.
Then there’s patient safety. The distance between home and where the procedure occurred is a clinical risk particularly if there are complications or a need for readmission. Language barriers, minor variations in medical practice and cultural differences add to the risks. Flights and transfers add stress for patients. There’s also an equity barrier – treatment overseas favours younger and wealthier people as costs must be paid up front before being reimbursed by the HSE. How could the State not get better value by spending that money on arranging treatment in a hospital in Ireland closer to the patient’s home, their loved ones and their referring doctor?
At a minimum, every patient seeking HSE approval for treatment abroad should first be offered treatment here instead in our private hospital system.
Meanwhile it’s mid-year and private hospitals are only now receiving public hospital referrals under the NTPF and have treated just a few hundred patients so far. While this has slowed growth in the lists, there is still a mountain to climb with 86,000 people on inpatient waiting lists of which 10,000 are waiting over 15 months. The €5 million allocated under the scheme equates to just one thousandth of the €5 billion spent within the public hospital system. And it appears a whole new procurement process will be required before a second €5M can be released which just adds to the bureaucracy.
The pace of progress to date has been glacial. We need disruptive action from our elected representatives to inject real momentum into the public waiting list initiative. We need policy makers to get on board and set aside ideology in favour of practical local private hospital solutions that can immediately put a real dent in the statistics and deliver significant relief to the hundreds of thousands of patients who are fast losing faith in the State to meet their medical needs.
Ireland’s obligation to refund treatment in private clinics abroad is something that has been foisted upon the system by means of an EU Directive. It is not something that would be invented here – how could it when the purchaser and provider of hospital services in Ireland (the HSE and the HSE) are not separate, as has been recommended in so many reports? Why would you open the door to other providers delivering equal or better quality care and value for money, than the hospitals you own yourself?
Simon Nugent is Chief Executive of the Private Hospitals Association