Peter Fitzpatrick (Louth, Fine Gael) | Oireachtas source

The Government has embarked on a major reform programme for the health system, the aim of which is to deliver a single-tier health service supported by universal health insurance where access is based on need and not ability to pay. Under universal health insurance, everyone will have mandatory insurance. There will be a choice of insurers, including the State-owned VHI. Insurers will be obliged to accept customers regardless of age or health status and will compete for business on the basis of price and service. The insurer will have contracts with providers in the public and private sectors to provide services to their customers. The State will subsidise or pay for the health insurance policy premiums of those who qualify on income grounds.

The current health system is unaffordable, unfair and unsustainable. The Minister for Health is committed to developing and implementing the most cost-effective system of universal health insurance possible. It will be fully compliant with Government expenditure targets. Initiatives to improve population health include effective community-based models of care, efficient money-follows-the-patient approaches and standardised value-for-money contract arrangements with general practitioners, consultants and other health care providers. These measures will be introduced over the next few years and will provide demonstrable evidence of lower cost and enhanced productivity and efficiency in the public and private health care systems.

The Minister is committed to ensuring that a comprehensive analysis of estimated costs is undertaken before the implementation of reforms takes place. Calculating the cost of universal health insurance is a complex matter which will require expert analytical support and time to undertake. The cost will be dependent on a number of decisions on the future of the model, including the package of services UHI will cover, and the scope and design of the financial support system. Other factors include a number of crucial and inter-dependent variables such as demand for the health care, service-delivery models, payments systems and regulatory and administrative costs. The Department of Health will progress work in 2014 with a view to its completion in early 2015.

There are a number of important stepping stones which must be put in place to pave the way for universal health insurance. Primary care services must be strengthened to deliver universal care with the removal of cost as a barrier to patient access. As part of the 2014 budget, the Government announced that it would commence the roll-out of a universal general practitioner service by providing all children aged six and under with access to GP services without fees. The work of the special delivery unit to tackle waiting times is another stepping stone as is the reorganisation of public hospitals into more efficient and accountable hospital groups delivering improved outcomes for patients. Another stepping stone was the introduction in January 2013 of a new statutory system of risk equalisation for the private health insurance market along with ongoing efforts to further develop risk equalisation to support community rating while promoting a sustainable market based on fair and open competition. A money-follows-the-patient policy was delivered in February 2013 and the phased implementation of the money-follows-the-patient funding system in acute hospitals was commenced in January 2014. National health care standards have been developed and there is ongoing work to support legislation.

The Government is committed to introducing universal health insurance so that everyone has health cover from an insurer of choice and access to high quality care on the basis of medical need rather than ability to pay. The Minister has signalled his intention to carry out by early 2016 all necessary ground work for the introduction of universal health care. He will proceed to have the new system implemented by 2019.

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