The health myths that have outlasted Mary Harney
Mary Harney may be gone from the health ministry but many of the myths (and bad policies) that the PDs propagated about the health system remain. In the first of a series of articles drawing out the neoliberal myths that have structured health policy, Sara Burke starts with some of the most basic.
Top of the myth list is the fundamental assumption that public healthcare is bad and private is good. In fact, if you are very sick in the Irish health system you will have to avail of the public health system and once you can get into it, you are better off within the public system.
Just one example of this is the expansion of private hospitals in to the 'emergency department' market. But by their very nature private 'emergency departments' are not what they say on the tin. Emergency departments are defined by the fact that they are open 24/7 and provide care for anyone, no matter how much money in your pocket or how sick you are. Private 'emergency departments' require payment upfront; are usually just open Monday to Saturday 8am to 8pm; and you have to pay upfront for care and to be able to walk in, as they generally do not have ambulance services.
The second major myth is that unequal access to essential health care is normal, that money not medical need opens the door in to the health system. This does not stand up to scrutiny if we compare with other contexts. In every other European health system, in Canada, New Zealand and Australia, as well as most other high-income countries, access to essential healthcare is based on need not ability to pay. Despite a decade of so-called health reform under the last three Ministers for Health – Brian Cowen, Micheál Martin and Mary Harney – not one of them even attempted to provide access to care solely on the basis of medical need.
Another major myth is that paying for care is a good thing; that people who can afford to should contribute towards the costs of their care. The argument continues that this in turn reduces public expenditure and unnecessary use. Mary Harney spread this fiction widely. Repeatedly she made the point that she was a 'fan of co-payments', that sharing the cost of care between the patients and the State was a better use of public money.
Yet the international evidence on this question is watertight. Charging patients for care no matter how little the charge puts off as much necessary use as it does unnecessary use. This means that charges stop people getting care they need, including such basic steps as going to the GP and continuing their medication use. The research shows that charges are particularly hard on people who take medicines for chronic conditions including mental illnesses, and those on low incomes and older people, especially women (who live longer). It also shows that, in purely financial terms, delaying early diagnosis and treatment costs the patients and the health system more in the short and the long term.
Of course, despite the proof ranged against them, Harney introduced prescription charges for medical card holders, who by their nature are amongst the poorest and sickest in Irish society. Even though Harney is now gone from office, the charges are still there, and these myths have not been dispelled.
And there are many more, which I will return to in the coming weeks.
Sara Burke is a journalist, broadcaster and health policy analyst. www.saraburke.com
(Image top via Adam Mulligan on flickr)