Public patients are all patients who do not have private health insurance (such as VHI, Bupa and Vivas) or who cannot afford to pay to see consultants privately. Fifty-two per cent of the population have private health insurance, 28% have a medical card (which allows free access and use of public health services) while 20% have neither private health insurance nor a medical card.

Why is this question so current?

Because of the huge public and media response to a letter read out on RT�? radio's Liveline show last week. A woman called 'Rosie' sent an email to the programme entitled "I am going to die because of hospital waiting lists". She spoke to Joe Duffy on Liveline last Tuesday telling how she had to wait seven months for a colonoscopy to diagnose her bowel cancer. The day before she wrote to Joe, she met another patient receiving chemotherapy for the same condition.

He was a private patient who got a colonoscopy and was diagnosed within three days of seeing his GP. By the time Rosie got diagnosed seven months after attending her GP, her diagnosis was terminal and she now has three years to live.

Rosie (not her real name) is 40, with two teenage children, is undergoing chemotherapy to prolong her life. She wrote the letter to Duffy having heard an advertisement from the Health Service Executive encouraging people with symptoms of bowel cancer to get it checked out.

What is the difference between being a public patient and a private patient?

All hospital services (apart from A&E) have two separate waiting lists - a private list and a public list. Public patients (anyone who cannot afford private health insurance or to pay private fees) have to wait longer for referral to specialist care and then for whatever hospital services that they need. Public waiting lists can be months or even years long. Some public lists are so full they are closed. Private lists are much shorter and usually patients can get appointments within a matter of days or weeks. The National Treatment Purchase Fund, set up to shorten public waiting lists, published data in December 2006, that shows that 15,096 adults and 2,300 children are waiting for surgical procedures. Of these, 32% of adults and 31% of children are waiting over 12 months. These times refer to waiting times from when a patient has seen a specialist. People often have to wait months or even years to see that specialist in the first place.

Private patients get their hospital care from a consultant, whereas public patients may be treated by a consultant or by more junior doctors, usually doctors in training. Some public patients may never see a consultant. A 2002 survey found that one quarter of public patients said they "rarely or never saw their consultant".

Public patients will always be in public wards whereas private patients may get semi-private or private rooms. Some private patients in public hospitals will have beds in public wards, particularly if they have high levels of medical need.

Why are private patients treated in public hospitals?

Irish health policy actively supports the treatment of private patients in public hospitals. While all Irish citizens are entitled to free (apart from a nominal fee) care in public hospitals, some private patients are also treated in public hospitals. Other private patients are treated in private hospitals. This happens for two reasons.

Firstly, since 1991, all public hospitals must designate an unspecified proportion of their beds as private. This means that private patients have a faster track to public hospitals than public patients. In 2002, 20% of beds in public hospitals were private.

More up-to-date figures are not available but in 2004, 33.4% of all patients discharged from elective treatments in public hospitals were private. Private patients in public hospitals pay 50-60% of the full cost of their care, the rest is subsidised by public money - many facilities are paid for by the public system, such as operating theatres and nursing staff. This means that public patients are subsidising private patients to get a better service, quicker than them.

Secondly, consultants in Ireland have contracts which allow them to practise privately as well as publicly. Salaries for consultants range from Euro120,000 to Euro160,000.

On top of this many consultants practise privately which can double their earnings.

Since 1997, the state has not offered 'public-only' contracts to consultants, thus incentivising consultants to practice private care. Mary Harney is in the process of renegotiating consultants' contracts and has said from 2007, the full cost of private care in public hospitals will be charged.

Is there a shortage of beds in the public hospital system?

It depends who you ask. The national health strategy, published in December 2001, promised to increase the number of beds in the public hospital system by 3,000.

Latest figures available from the Department of Health (from May 2005) show that 535 additional in-patient beds were introduced since December 2001. Professor Brendan Drumm, the CEO of the Health Service Executive, said in October 2005 that Ireland was "over-equipped with acute hospital beds by international comparisons". Doctors' and nurses' unions contest this.

Maev Ann Wren and Dale Tussing in their 2006 analyses of the Irish healthcare system using up-to-date census data show that in order for Ireland to stay in line with EU average an additional 4,134 beds are needed over the next 10 years. A recent ESRI survey on hospital bed capacity found that an extra 2,277 beds are needed from 2007 to 2012 to meet the population's need.

Does it have to be this way?

No, the government could decide today to introduce a common waiting list for all public and private patients. This way waiting times for public patients would fall while waiting times for private patients would rise but all patients would be treated on the basis of medical need, not ability to pay - a fundamentally fairer system in accordance with medical ethics.