Pay As We Go Social Provision The Core Of Ireland’s Hybrid Healthcare System

Recent posts and comments on IrishElection.com have opened up the question of different models of public, private and hybrid systems of provision for healthcare. The issue seems capable of rational analysis to arrive at the most suitable solution for the time and place we are at in Ireland. I don’t believe that a purely ideological analysis from either left or right is helpful.

The state has many economy and efficiency reasons to be involved in direct healthcare provision, enabling provision, and market regulation. Those are hard reasons, to add to the soft reasons like compassion, prevention of epidemics, having a productively healthy workforce to keep the exchequer accounts buoyant, and the utilitarian desire to keep the pavements free of sick beggars.

Firstly, health and wellbeing make up a huge portion of a modern service and enterprise economy and of total employment in the state. It is not inevitable that that should be so, but is rather the result of past decisions. In the final shakeout, money not spent on this sector would be more likely to end up where all surplus wealth ends up, in property values.

Secondly, there is a brand premium for Ireland Inc. in its efforts to attract high-paying US and other healthcare research and manufacturing investment, from the demonstration effect of the community having a commitment to an advanced level of healthcare for our own people, young and old.

Thirdly, a healthcare system based on voluntary private insurance cannot by definiton be universal, and arguably it would be oppressive for a state to compel citizens to become customers of any commercial provider. It would also be wrong to require people to avail of therapies and procedures they didn’t want, and in the case of health it would be coercive to force people into any investment-based insurance product which was not underwritten by the state itself.

Fourthly, the power imbalance between the dentist’s or opticians’s customer, or the doctor’s or A&E patient, on the one hand, and the practitioner, consultant, institution or bureaucracy on whose undistorted and altruistic engagement the citizen is reliant at his vulnerable time of need, is too big to be left to market forces.

Fifthly, the cost bases of the pharmaceutical, medical technology industries, and of comprehensive hospital facilities, are such that in a market of Ireland’s size it is necessary to make rational decisions about organizing the different levels of healthcare provision so that optimal use is made of the best available technologies, trained specialists, and of money available for treatments.

NASA defines a system as ‘a set of interrelated components which interact with one another in an organized fashion toward a common purpose’. Ireland’s healthcare system needs to meet this definition by whatever means necessary. That means that the HSE, the government, and the backbenchers must use the power the people have given them to get the best results out of the public spend, and rise above the localism that has given us bored specialists without enough to do scattered across the state in little old hospitals.

The economics of scale should ensure that the most committed specialists will choose to work in the centres that only a well resourced pay-as-you-go state health system can provide in a territory Ireland’s size.

I don’t want to undermine the demonstration-effect and credibility of all the investment specialists operating at the Irish Financial Services Centre by questioning the innate worth of their managed funds. But hell, I’m trying to be honest.