‘We have a right to know who will pick up the bill for abortion regime’
THE likely economic cost of providing the kind of abortion service envisaged by the Health Minister and Taoiseach within the public health system has attracted little attention.
This is difficult to understand. The costs, and the difficulties, of accessing healthcare is the single most pressing and sensitive issue in Irish politics.
There are a number of points that can be made. There are the direct costs; additional specialists in obstetrics and maternity as well as new facilities. There are also very significant indirect costs, eg follow-up, referral and mental health services which are wholly inadequate even as matters stand – quite apart from “overheads” attributable to health and administrative staff, facilities and other related costs.
Importantly, there are also what economists call ‘opportunity costs’, ie the services that would, inescapably, be crowded out by abortion-related expenditure.
Every year the Government makes decisions on the health services to be made available or to be cut back. In a public health system which, we know only too well, is constrained by rationing – from waiting lists to overcrowding – this issue cannot be papered over by assertions that the costs of elective abortion would be met “whatever it takes”.
Medical and surgical priorities are identified in the annual HSE Service Plan and the necessary resources allocated to fund them.
It is not clear on what basis the Government could assert that the costs of funding elective abortion should be prioritised above all other services.
This would inevitably mean shortages elsewhere in the system. There is no getting around that reality.
It would also be important to know, for example, whether the Government’s political priorities correspond with those of GPs working in primary care or medical, nursing and midwifery
services in the acute system.
A central issue relates to what proportion of the cost-burden would devolve on private health insurance (and, therefore, on health insurance premia) compared with directly on the Exchequer. We know that the Government long used private health insurance as a “cash cow” for an underfunded health service.
This would certainly increase. Procedures such as elective abortion are demand-led. Once normalised, they are driven less by need than by want.
Abortion is not a ‘public good’, which is how healthcare is widely defined. We are not talking about medical terminations. We are speaking about elective procedures within a context where there is, and has long been, significant pressure on non-elective procedures and on the wider health service.
All of this is over and above the very problematic issue of using private profit-driven providers versus the public sector.
These costs cannot be ignored. They are likely to be far greater than the Government has been willing to acknowledge. Consider, for example, the prohibitive costs of liability insurance – medical indemnity – with which the Department of Health and the courts have to deal.
There can be little doubt that the costs would escalate. And there is no doubt whatever that there will be overruns.
So, it’s reasonable for voters to ask: what are the estimated costs of the Government’s proposals, where is the funding to come from and what services will be displaced to accommodate them?
My own primary objection to the Government’s proposed abortion regime relates to the denial of human rights that it entails and its negative impact on women.
Even so, that does not preclude addressing the very significant economic burden which the Government’s proposed legislation would impose on our overstretched health service.
The Government has long highlighted the importance of “economic impact assessment”. It should be straightforward in putting before the people the likely economic burden on the health sector of its proposals. Ray Kinsella is an economist and former professor of banking and financial services, and healthcare at UCD Michael Smurfit Graduate Business School.
These costs cannot be ignored and they are likely to be far greater than the Government has acknowledged