Thursday, 3 May 2012

Modern Titanics (5)- Sustainability of health services

Our politicians have been promising that public health services would remain free. They would immediately shoot down any suggestions, no matter how sensible, that would expose them to criticism of breaking their promises, especially at this time of the political cycle.

Yet our politicians know better than most that universal entitlement to free health services is unsustainable if we are to protect macro-fiscal stability.  With extended longevity, higher dependency on health services in the extended years at the margin of longevity and spiralling costs for delivering health services, there is no doubt that if health services are to remain universally free than their access has to be rationed.

We are already seeing such rationing in the form of waiting lists for surgery related to non-life threatening conditions, patients accommodated in corridors and bottlenecks in the Emergency and Admission Department.   In the Care of the Elderly they are showing in waiting list for accommodation in Public Residential Homes for the Elderly.

Such rationing discriminates against the poor and the lower strata of society.   Without the social connections of the higher echelons who can use such connections to skip the queues and cut their waiting time, the poor have no option but to wait, sometimes interminably.   

For the rich and upper middle class the situation is not rosy either.   Doubts about whether they can rely on public health services when they need them, force them to buy private health insurance cover.   So they pay for public health care through general taxation and they pay again for private health care services through private insurance.

Sooner or later someone has to sort out this confusion and waste of resources.    At some point in time our politicians have to put their heads together and agree that universal entitlement is neither social nor efficient.    Social responsibility demands that tax euros are used to help those who need it not everybody irrespective of social needs.   Universal entitlement involve inefficient transfer payments where high taxes are paid to government so that government can then provide for taxpayers' free health services.  It would be far more efficient if government reduces taxation and only offer free health services to those who really cannot afford to provide for them through private insurance.

Probably nothing will happen until we hit the iceberg and then it may be too late.

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