Dr. Marita O'Brien:

That could be one of the first things to look at in the context of universality. Who is entitled to chronic disease management? Is it a question of one's means? That is a very simple thing to think about in the sense of what we mean by "universality". If we want people with chronic diseases to manage their diseases, keep well and stay out of acute hospitals, there cannot be too much of a cost involved for them. As such, the cost impact of people failing to participate, if it is an individual thing, must be looked at. As Ms Loughnane said, it is more to do with capacity, but in thinking about universality, the question is whether we want everybody with a chronic disease to manage to go to their doctor to have the proper tests for COPD or cardiac issues and for stroke prevention care.

If somebody has had a stroke, how do we prevent another one? If there is going to be a cost to the individual, is he or she going to continue to have tests? Universality can benefit people so much by allowing them to access those things when they need them in a timely way rather than to put them off for years.