104.6 per cent compared with 107.8 per cent in Germany, 81.1per cent in Britain,71.8 per
cent in Sweden, 65.8 per cent in the United States and reductions in the cost ratio in
Australia, Austria, and Finland. Inpatient price indices for the years 1960 to 1983 show the
Irish increase, at 20.3 times compared to 10.9 in the United Kingdom and 9.3 for sixteen
countries. Only Italy at 21.7 exceeded the Irish inpatient price index growth. (OECD, 1990).
In addition to meeting 75 per cent of the total health bill the government in Ireland provides
assistance to private health expenditures. The White Paper lists the most prominent incentives
by the State to private health insurance as tax relief on health insurance contributions, public
hospital charges to private patients at below the economic cost and the bearing of costs by
the state in relation to accident and emergency services, national and tertiary specialities and
professional training (WP, 75).
The White Paper estimated the cost of private health insurance tax relief in 1999 at
£62m. (WP, 24). The private hospital sector provides 2,500 private and semi-private beds
compared to 2,500, also designated as private beds in public hospitals, some 21 per cent of
the total beds in public hospitals. The White Paper estimated that there was a subsidy of
£35m to private patients in public hospitals because " the charges are not explicitly related to
the real costs of maintaining and providing services to private patients and are intended only
as a contribution to the cost of care in public hospitals." (WP. 25). The White Paper states
that " the Government will therefore make arrangements for the phased introduction of
economic pricing over a period of 5 to 7 years." (WP, 26).
Of the 12,292 beds in public acute hospitals 21 per cent are designated private beds
and 6 per cent are non-designated. No charge is made for these " non-designated" beds to
private patients according to the White Paper " even though they would be in receipt of
intensive and costly care at the time. This is a particularly advantageous situation for insurers,
as public hospitals carry the costs of the services provided to insured persons." (WP. 26).
Of 1,208 medical consultants, only 250 or 21 per cent are entirely in private practice.
The White Paper states that the fee per item system of paying consultants in public hospitals
in respect of their private patients compared to salary in respect of public patients suggests
that " a stronger incentive exists for those consultants who are significantly involved in
private practice to devote a disproportionate amount of personal time on these private
patients. This situation is exacerbated by the fact that the private hospitals employ relatively
few consultant or other medical staff of their own, relying to a great degree on the availability
of doctors who also hold public contracts." (WP, 13). The contrary point is, of course, that