A new book challenges the current direction of the health service and accuses the Minister for Health, Mary Harney, of adopting policies which will have long term damage on the Irish health service. How Ireland Cares, written by Professor A. Dale Tussing and MaevAnn Wren, shows how Ireland has one of the lowest spending rates on health care in Europe and is suffering from a chronic shortage of doctors.

The book also shows the inequalities in Irish health care, where unskilled manual workers are twice as likely to die prematurely then higher professionals.

The construction of private hospitals leads to a twotiered health system and encourages 'cherry-picking', whereby hospitals focus on profitable services and scrap financially risky services. Attempts to privatise the VHI will lead to similar problems, with a privatised health insurer focusing exclusively on profitable customers, it is claimed.

"One should not be doctrinaire and oppose such privatisation in health care on principle, but one should always be aware of the potential privatisation has for doing harm, especially in those circumstances where externalities, cross-subsidisation and the potential for inequalities are likely to exist, " say the authors. "For this reason, we advocate that the government should abandon its plan for private hospitals on public hospital grounds."

Although the construction of private hospitals will lead to more acute hospital beds, it will not free up private beds in public hospitals for public use on anything like a onefor-one basis. There is also a danger that consultants would favour treating patients in the private hospital if they were made shareholders in the new facilities.

The crisis in the Irish health system is reflected in the fact that Irish life expectancy is below EU average. Life expectancy for Irish males is 75.1 and for females is 80.3, compared with EU average of 75.8 and 81.6 respectively.

The book highlights the manner in which Irish people on lower incomes suffer more illness and die younger than better-off social groups. Unskilled manual workers are eight times more likely to die as a result of accidents than professionals and twice as likely to die prematurely.

Unemployed women are more than twice as likely to give birth to low birth-weight babies as women in the higher professional socio-economic group.

By spending 8.9% of GDP on health care, Ireland is below the EU average of 9%. Ireland ranks ninth in the EU in terms of spending on health. With 11.1%, Germany ranks as the European country that spends the highest percentage of GDP on health care. While spending on health has increased significantly over recent years, this is due to the massive cutbacks the industry suffered in the late 1980s, say the authors.

"Current and capital spending on health still needs to increase to fund the capacity deficits identified in the Health Strategy . . . in primary, continuing, community and acute care, " according to the book.

The shortage of practising doctors is a major problem in the health service. Ireland suffers from one of the lowest ratios of doctors to nurses in the western world, with just 159 practising doctors per 1,000 practising nurses.

This compares with 808 in Italy, 883 in Spain, 289 in the United States and 1,121 in Greece.

"The cap on Irish (and other EU) students in Irish medical schools must be drastically raised, as the Fottrell Working Group recommended, and the government accepted, early in 2006, " the authors say.