A READER has sent in a lengthy objection to my support for private health insurance. It is her view that the very presence of the VHI, Bupa and Vivas health insurers has caused an inequitable system of care and the problems of long treatment waiting lists and chaos in accident and emergency departments.

Yet as the 2004 report of the National Treatment Purchase Fund (NTPF) shows, health service providers that operate separately from the government continue to prove that when the dead hand of bureaucracy and interference is removed, efficient, high-quality and good-value healthcare is perfectly possible.

The NTPF, which was set up in 2002, has been able to cut in half the long-term waiting list for operations by sourcing private medical treatment for patients here, in Northern Ireland and in Britain. Last year 13,627 patients were treated this way, at a cost of €44m. This represents 0.4% of the total spent on health in the 2004 budget.

Nearly 95% of that money was spent on patients and just 5.73% on administration. In all, 23,379 patients have been treated via the NTPF since its inception, though there is still considerable resistance by consultants and administrators in about half of Ireland’s public hospitals to support the scheme.

The question is: how can 25 people in a small, independent agency get nearly 14,000 patients treated annually in a fraction of the time it usually takes, and with a fraction of the usual administrative costs, when thousands of administrators who run the public health service, with most of the available health budget, are utterly incapable of doing so? However they do it, every hospital in the country should be let in on the secret.

I don’t suppose I should be celebrating the fund’s success too enthusiastically, or some civil servant will probably come along and try to close the NTPF down for keeping its costs low, for “cherry- picking” the sickest patients and for showing up the inefficiencies of everybody else.

Grey lobby flexes muscles

We may be seeing the beginnings of a real “grey power” lobby in this country. And it’s high time, too.

Voluntary organisations such as Age Action Ireland have been gaining public support as a result of such scandals as the overcharging of nursing home patients and discrimination against older people by employers and the public health service.

Now it seems an Oireachtas committee on social welfare may be lending its support to another issue that lobbyists for pensioners have been raising for some time — the clawing-back of overpayments from the estates of non-contributory old-age pensioners who were able to save some of their pensions.

Non-contributory pensions are means-tested and, from 1979 to 1997, the total means you could have before the maximum non-contributory benefit was reduced or lost altogether was just €200. It then rose to €12,000, and at the end of this month will go up to €28,000, to accommodate special savings incentive account (SSIA) windfalls.

Pensioners who somehow saved money from their pensions over those limits and didn’t own up were defrauding the state. If caught, their pensions were cut or, if they died, their estates were forced to refund the overpayment.

The Oireachtas committee is trying to sort out who knew what about such assets and whether pensioners were sufficiently aware that they would be defrauding the state by accumulating savings that exceeded the means-tested threshold. (It was well flagged that existing savings and investments would be means-tested.) This shouldn’t be an issue in the future, after the threshold rises to €28,000, but for hundreds, if not thousands, of elderly pensioners who might have built up savings from their pensions over many years, it is a extremely live issue indeed.

Lobbyists say that department officials have conceded to the committee that the clawing-back facility was not something pensioners would have been aware of, and that it was not well-publicised in any of the usual pension literature.

At the moment, the department is insisting that pensioners who accumulated “excessive” savings from their means-tested pension will be subject to claw-back.

Ironically, the thousands of elderly people in nursing homes who are to receive pension refunds of up to €29,000 from the Department of Health have been promised that this money will not affect their means-tested pensions or be clawed back after they die.

What Age Action Ireland and the other grey lobbyists want is the same treatment for retired people who stayed in their own homes and were able to save relatively small amounts from their pensions.

They say it is now up to the minister for social and family affairs to do the right thing and exempt such savings from his list of means-tested assets.