James Reilly (Dublin North, Fine Gael)

I propose to take Questions Nos. 8, 17, 42 and 958 together.

The Government is committed to fundamental reform of the health system. This will see the delivery of a single-tier health service, supported by universal health insurance, which will ensure equal access to care based on need, not income. The universal health insurance system will be based on the principle of social solidarity. Every citizen will have a choice of insurer and equal access to a comprehensive range of curative services. A new insurance fund will subsidise or pay insurance premiums for those who qualify for a subsidy.

Key features of the reform programme which will underpin the introduction of universal health insurance include the strengthening of primary care services to deliver universal primary care with the removal of cost as a barrier to access for patients. It is a paradox of the current system that that which is the most efficient and cost effective, that is, primary care, has a cost associated with it and a barrier and that which is most expensive, that is, hospital care, does not. The work of the special delivery unit will continue in tackling waiting times - this relates to both scheduled and unscheduled care. The key features include the introduction of a more transparent and efficient "money follows the patient" funding mechanism for hospitals, and the introduction of a purchaser-provider split, whereby hospitals will be established as independent, not-for-profit trusts.

In addition, I recently announced significant changes in the governance of the Health Service Executive, under which the current board-chief executive structure will be replaced with a directorate or transitional governance structure. This new directorate structure will facilitate greater transparency, accountability and efficiency, and is a key component in the move to universal health insurance.

The reform programme is a complex and major undertaking that requires careful planning and sequencing. Detailed consideration must be given to the optimal structures for delivery of services and the critical inter-relationships between services, as well as best practice in health care reform. My officials and I have attended numerous meetings with interested parties at which various aspects of the reform programme have been discussed. These included a study visit by my officials to the Netherlands in June last year to examine the Dutch health insurance model. In addition, my Department organised a seminar on universal health insurance which was attended by experts from the Dutch Health Ministry, the World Health Organization and the European Observatory on Health Systems and Policies. Such contact with relevant bodies, both at national and international level, is vital to enhancing our knowledge and informing policy. I see it as imperative that we continue to engage with interested parties and gain from the experiences of other countries in this area. Ultimately, however, the Government's reform proposals will be designed to meet the needs of the Irish people and system and ensure the best outcome for Irish patients.

In order to assist in developing detailed and costed implementation proposals for universal health insurance and help drive the implementation of various elements of the reform programme, the Government has approved the establishment of, and the terms of reference for, an implementation group on universal health insurance. I am finalising details of the implementation group, including its composition, which I will announce shortly.

The implementation group will have responsibility for assisting the Department in preparing a White Paper on Financing Universal Health Insurance which will outline the estimated costs and financing mechanisms associated with the introduction of universal health insurance. The White Paper will be published towards the end of the year. However, it must be borne in mind that the precise cost of universal health insurance will depend, to a large degree, on the implementation of various reform measures as outlined. This highlights the importance of driving performance improvement and progress on reform across the health system as quickly as possible.

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