Dr. Bridget Johnston:

Financial protection is linked in with the access question. We saw the bar chart with the double insurance holders. Essentially, they are covered by the public system by having a medical card but also continue to pay out of pocket for private health insurance. For those who do not, we see a large proportion of that spend, which is not affordable, is to access private care. People cannot wait on the lists. It is not just an issue of making it more affordable and reducing those charges but also ensuring that people feel well looked after in the public system and they are not paying in a way they cannot afford.

Sláintecare is clear that the care is either free at the point delivery or at the lowest possible cost. A number of charges have been introduced over the past several years which bring medical cardholders into the fee-paying fold. We have already designated that these households are not able to afford them. When we look at the comparison over the years, we see that charges for prescription drugs are driving much of the unaffordable spending for the poorest and most vulnerable households. It is important to ensure the most vulnerable households are not paying for care they cannot afford. That is a significant part of their experience of accessing healthcare. It prevents them from fulfilling their prescriptions and adhering to their medication. It is a serious problem that we need to address.

On the lowest possible cost, Sláintecare does not talk about removing the drug payment threshold but lowering it to a more affordable threshold. There is not this sense of free care everywhere. We are an outlier in the European context in that we do not offer free primary care. People either have basically free GP care or they pay the full cost of it. Even within the GMS, we know patients are paying for signing off on their disability forms and other small charges to primary care providers at the same time. We need to ensure that the safety net is doing what it is meant to do.