Alex White (Dublin South, Labour) | Oireachtas source

The current health system is both unaffordable and unfair and it is, therefore, unsustainable. The current system can be and is being improved but there are limits to what reform of a fundamentally flawed system can accomplish. If we want to realise the health service we want, radical reform is the only option. This Government made a commitment to the kind of radical reform that we need to tackle one of the most profound inequalities in Irish society. We committed to introducing a system of universal health insurance so that everyone has health cover from his or her choice of insurer and has access to high quality care on the basis of medical need rather than ability to pay. The publication earlier this month of the White Paper on universal health insurance underpins the Government's determination to deliver on that commitment. We were clear from the start that achieving this goal would require at least two terms of office. The job of this Government is to put in place the building blocks so that a fair and cost-effective system of universal health insurance can be delivered by 2019.

The delivery of a single tier health system, supported by universal health insurance, is a central pillar of the Government's overall health reform programme. Our aim is to ensure more efficient and effective delivery of services so that we can move away from a hospital-centric model to one that provides the most appropriate care in the most appropriate setting. The introduction of universal health insurance is the most radical reform of the Irish health system since the foundation of the State. It requires both time and careful planning to implement. It is this Government's goal to put in place the essential groundwork to underpin universal health insurance in this term of office so that universal health insurance can be implemented by 2019.

The White Paper identifies and outlines progress to date on the key structural, regulatory, financial and information-related building blocks that will pave the way for the introduction of universal health insurance. Yesterday, the Government approved the legislation to enable each of the 420,000 children in Ireland aged under six to access a GP service without facing the barrier of fees. This legislation will bring Ireland into line with health systems in Europe that ensure that all children can access a family doctor when they need to do so. The Government has provided new, additional funding of €37 million to meet the cost of this measure. This represents the first step in introducing a universal GP service for the entire population. Ultimately, under universal health insurance, every member of the population will have a universal entitlement to the core primary care services provided by GPs.

A number of Deputies have referred to the fact that I have been in touch with the representative bodies for GPs, engaged in correspondence with them and have invited them to meet me in connection with the draft GP contract, published last January, which the HSE put out for public consultation. I would encourage the GP representative bodies, in particular the IMO, to take up the offer of real engagement, consultation and negotiation that I have extended to them. The only way we can proceed with this reform - or any reform of public policy - is through dialogue. That is absolutely essential in this case, as much as in any other area of public policy. I must emphasise, in response to what Deputies have said, that it is the intention of the Government, and my intention in particular, to have a very real and meaningful engagement with the representative bodies for GPs. To anyone who thinks that it will be anything less than full and comprehensive, I must say that is not the case and is not my intention. I must also emphasise that the negotiation and consultation process that I have offered can extend to each and every one of the concerns that have been raised by GPs and their representative bodies in recent weeks. I exclude none of the issues from that process that Deputies, in the course of this debate, have referred to and are aware of from their own contacts with general practitioners.

The universal health insurance White Paper sets out the details of the methodology for determining the future health basket. This includes both the services that will be funded under universal health insurance, as well as the ongoing management and review of the future basket. The paper includes consideration of the options for financing UHI and deals with the key regulatory and cost control frameworks governing the universal health insurance system. The basket of services, in particular, is a matter that has been referred to by many Deputies in the course of this debate, including Deputy Buttimer most recently. I welcome the decision of the Oireachtas Joint Committee on Health and Children to host a consultation process on this. While it is entirely a matter for the committee, the decision follows on foot of an invitation to do so issued by the Minister and the Department of Health. The committee, as has been the case in the past, can make a real contribution to the development of universal health insurance. The committee has been invited to make recommendations on the values framework that will underpin decisions on the future health basket and to consider the options proposed by the expert commission.

All of these questions, including those on the basket of services and which particular services should be funded through universal health insurance, directly by the State or through individuals' own resources, are of fundamental importance to every citizen of this country. The answers to these questions are not simple but are complex, multi-faceted and involve various technical, economic and ethical considerations. These are deeply value-laden decisions and it is therefore important that the values underpinning the health basket reflect the values of broader society. Good practice in other jurisdictions in these decision-making processes involves a critical blend of both technical appraisal and comprehensive consultation with all relevant stakeholders, including patients, patient advocacy groups and others with an interest in these issues, as well as the citizens of the country. An expert commission will be tasked with developing detailed costed proposals on the composition of the future health basket, including those that will form part of the universal health insurance package of care. As part of its work, the commission will consult with both the public and with system stakeholders. Responsibility for the final decision on the services to be provided under UHI will of course rest with Government.

Universal health insurance represents a substantial shift in how we finance and organise the Irish health system. The White Paper sets out a comprehensive cost control framework to ensure affordability and to contain costs, which is a very real concern. These controls range from price monitoring of insurers and setting maximum prices for health care providers, to more aggressive measures such as capping insurer overheads and profit margins. Ultimately, the cost of universal health insurance in Ireland will depend on a number of key decisions, including the basket of services to be covered and the scope and design of the financial support system. These issues remain to be addressed and resolved. Work is already under way to further develop and refine proposals on cost control mechanisms, the financial subsidy system and, critically, costed recommendations for the basket of services to be provided.

Delivering a single-tier health system, supported by universal health insurance, is central to achieving our policy vision for the health system, a vision that is far-reaching and ambitious. We want everyone to have an opportunity to contribute to the development of our universal health insurance policy and help us to ensure that the major changes are put in place in the best possible way for the benefit of everyone. So I urge individuals, local groups, national organisations and other bodies to participate actively in the consultation processes and make their views known on the future funding and delivery of our health services.

Whether we ask who will be funding the health service in five or ten years' time, the answer is that it will be the Irish people. The real question is how they will fund it. Will it be through the universal health insurance system we advocate and seek to put in place? If so, how should it be configured and what services should be included? All questions that are required to be addressed can be addressed in the course of the debate.

I ask Deputies opposite, particularly those who have opposed this set of proposals at the outset, to agree with the following proposition at least. What we have in the White Paper is a serious contribution to the debate we must have on the future funding and organisation of our health services. It is at least worth an airing and a fair wind. It is our first opportunity to tease out and scrutinise the issues associated with the vexed question of funding of health services. Which services should be funded and how? This is the first time we have given ourselves that level of opportunity via the publication of such a comprehensive statement and set of data. These are not simple issues and their resolution will not be easy.

I heard Deputy Joe Higgins recall earlier the great achievement of the British Labour Party after the war in putting in place the great NHS system. One must ask whether any electorate can now be persuaded to fund an NHS system purely through taxation. I do not say that advocating the NHS model is illegitimate, but let Deputy Higgins and others get involved in the debate on the basis of the proposal we have put in place. Let parties opposite come forward with their alternatives. It is for the Opposition to oppose, with which principle I do not quibble. I do not expect the parties opposite to support uncritically what the Government proposes any more than we would if we were over there. However, in this area of public policy more than any other, we should have a concerted debate and discussion and share views and insights into how we want our health service to function in future.

It is a health service for the people of Ireland that we want to put in place. I do not exclude politics or even ideology from the debate, but I ask that we have a frank and open discussion based on evidence. The White Paper on universal health insurance is the best possible grounding for that debate. I commend it to the House and thank Deputies for their contributions. I look forward to continuing the debate with them.

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