Brendan Smith (Cavan-Monaghan, Fianna Fail) | Oireachtas source

The Minister's White Paper falls a long way short of the programme for Government commitment which stated that a White Paper on financing universal health insurance would be published early in the Government's first term. We were told it would review cost-effective pricing and funding mechanisms for care and set out the care to be covered under UHI. We are now in the fourth year of the Government's term, which is not early by any stretch of the imagination. Not only is the White Paper late, it lacks any concrete information as to how it will be financed and how much it will cost people if the policy is every implemented. The truth that the Minister and his White Paper miss is that universal health insurance does not equate to universal health care.

What the Minister is proposing here could end up being very expensive for the already hard-pressed middle income earners. All of us who are public representatives know very well that many additional burdens have been placed on the cohort of people who do not have any more to give to meet extra demands. The White Paper fails to provide clear and concise answers to a range of other big questions, such as what will happen to primary care if the Minister gets his way, and whether, by introducing free GP care, the Minister will effectively make every GP a public servant.

There is no doubt our health system needs further reform so all patients receive health care on clinical need, but there needs to be a real national debate on how best to achieve this. A national debate can contribute to arriving at the proper architecture. There is a need to assess whether the Dutch model, to which the Minister so often refers, is suitable for the Irish health system and whether in reality it will result in better health care. When the Minister was in opposition we constantly heard him refer to the attractions of the Dutch model. While the system has some positives it also has some major negatives, as outlined by two Mullingar general practitioners, Dr. Wilkinson and Dr. Brennan, in an article they wrote some time back for Forum, the journal of the Irish College of General Practitioners. They quote the Commonwealth Fund report which ranked the Netherlands second to the UK in its ability to provide same or next day appointments to patients. Although, as they point out, Ireland was not included in this comparison, anecdotal reports from the UK suggest that waiting times for appointments in general practice are shorter in Ireland than in Britain. Will longer GP waiting times be the price of Dr. Reilly's expensive system? Those of us who flick through the news channels when we come home late at night see reports on the British channels of the difficulties people there have in accessing not only hospital care but immediate and ready access to general practitioners. It is a real problem. There is also a problem in some parts of our country, but not the delays we hear about in other countries.

Of more concern is the fact the report rated Dutch patients as second most likely to be hospitalised due to a complication after discharge. As the doctors themselves state, this may be a side-effect of a Dutch health care system where hospitals are paid per patient treated and procedure performed. Dr. Wilkinson and Dr. Brennan quote one of the Dutch delegates to the European Society for Quality and Safety in Family Practice, Dr. Veld, who concedes the Dutch system has its downsides. He states the basic insurance package is expensive and the costs of premia have increased by 40% over a four-year period. Not only have the costs increased but the content of the packages has already been reduced with a range of treatments and medications, such as ulcer drugs, tranquillisers and anti-depressants, being withdrawn and discussions are taking place on how the packages may be reduced further. Dr. Veld sees a threat to risk equalisation as insurers may alter the conditions for supplementary packages for people with pre-existing conditions, making it harder for such patients to change from one insurer to another.

A medical system funded by insurance companies ensures a competitive market. This is acceptable when it comes to routine procedures such as cataract surgery or hip replacements. However, Dr. Veld highlights the ethical issue of hospitals competing financially in their ability to manage life-threatening conditions such as cancer care, which could compromise treatment as a result. As insurers try to source the cheapest generic drugs, many patients obtain pills with different brand names or boxes every three months. The Minister knows better than the rest of us in the House this can prove distressing for patients at times, particularly older people, and compliance is compromised as a result.

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