Dr. Bridget Johnston:

The slide dealing with affordability and sustainability from a financial perspective for the Government asks how affordable is health care for households in the current model and the way we are funding it. Currently about 68% to 70% comes from general taxation and the remainder of funding comes from private health expenditure. That is what households either spend out of pocket at the time they access health care or the reimbursement that comes from private health insurance companies back into the system. They contribute about an equal pot each, about 15% each.

Some of the work I have done for the pathways project is to look specifically at the affordability of this spending by households. Using the household budget survey provided by the CSO, I have been able to estimate that 14% of households were not able to afford what they were spending on either out of pocket charges or private health insurance premiums in 2009 and 2010. By the year 2015 to 2016, this had grown to 17.3% and that probably should be seen in the context of rising charges throughout multiple budgets, but also the increase in private health insurance premia.

What is interesting to look at on this slide is who is mostly affected by this, what these households look like, and what kinds of protection are they supposed to have from the system so that they do not experience this financial hardship. The top bar for the years 2009 and 2010 shows that the majority are medical card-GP card holders. Those represented by the blue bar are considered double, so they not only have a medical card but also private health insurance. They are meant to be protected by the medical card system as well. We can see they are the overwhelming majority of people who are not financially protected, experience financial hardship, and are pushed further into poverty or into poverty because of their spending on either of these items. We can see this grew substantially by 2015-2016, not only for the proportion of households but the breakdown within. We can see that the safety net that is meant to be provided by the medical card scheme is failing those households. This is the overwhelming majority of those who are experiencing financial hardship. In its current form, this system is not protecting people as well as it should.