Sir, – Lisa Kelleher’s letter highlights the weaknesses of subjective assessments of our healthcare system and contrasts the Irish healthcare system with that of Italy (“Self-reported rude health of Irish adults is an unhealthy basis for policy”, Letters, May 23rd). Perhaps the most dependable objective measure of any healthcare system is longevity, since it is difficult for people to grow old if they are burdened by ill health.Both Ireland and Italy rank near the top of OECD life-expectancy tables, with life expectancy at birth in Italy approximately one year higher than in Ireland. However, Italy spends approximately €2.3 billion per million of population on healthcare, compared with Ireland’s €5.4 billion – or closer to €6 billion if private health-insurance contributions from almost half the population are included.Italy, therefore, achieves greater population longevity while spending only 43 per cent of what Ireland spends. There are many reasons why such vast sums are spent here for a poorer return than that achieved in Italy.A key factor is the lack of an evidence-based approach to health-service delivery that properly future-proofs health investment, considers unintended consequences of change and avoids a politically-populist approach to healthcare provision. Ireland also remains something of the “Wild West” when it comes to the supernormal profits generated by pharmaceutical companies and private health insurers. A far more rigorous approach to expenditure across multiple parts of the Irish health system could substantially reduce the State’s current €29 billion exchequer spend and leave us just as healthy. – Yours, etc,DECLAN LYONS,Ennis Road,Limerick.