Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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2. To ask the Minister for Health his views on the report by the World Health Organization, WHO, that has raised concerns regarding the Government's plan to introduce universal health insurance, UHI, and mentions European examples where insurer competition has proved ineffective in improving efficiency and controlling costs, including the fact that no country has been identified in which costs went down on the introduction of such a model based on competing insurers; and if he will make a statement on the matter. [8164/15]

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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In light of the WHO report that has questioned the Government's plan to introduce UHI, I seek to establish the Minister's most up-to-date thinking and intentions regarding the Government's proposed UHI-based health care model.

Leo Varadkar (Dublin West, Fine Gael)
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I am aware of the WHO report referred to by the Deputy. My Department provided information and observations on an early draft of that report. The report emphasises the need for reform of our health services and acknowledges that the Government is the first in the history of the State to commit to the principle of a universal, single tier health service which guarantees access to medical care based on need, not income. The first concrete manifestation of that will be seen this year by extending GP care without fees to the younger and older in our society. We remain committed to the goal of universal health care and to driving forward reforms in other areas such as extending GP care without fees to other groups, further widening discretion for medical card based on medical need as well as income, improving the management of chronic diseases, establishing activity-based funding, establishing hospital groups, and making health insurance more affordable. These initiatives are important reforms in their own right that will drive efficiencies and bring benefits in advance of moving to a system of universal health care. This Government's commitment to major reform is long overdue with the report noting that reform "was largely ignored in the pre-crisis period".

With regard to the potential cost of a competitive universal insurance system, my Department is working with the ESRI, the Health Insurance Authority and others on a major costing exercise. This exercise will examine the cost implications of a change to a multi-payer, universal health insurance model, as proposed in the White Paper on UHI. The analysis will include a review of evidence of the effects on health care spending of alternative systems of financing and changes in financing methods and entitlements. It will also estimate the cost of UHI for individuals, households, employers and the Exchequer. I expect to have the initial results from this exercise in April, following which I will revert to the Government with a roadmap on the next steps to UHI.

The work of the WHO and others points to the fact that there is no magic prescription for all countries when it comes to health service reform. At different points in their development, some health services may be charged with control of excessive costs while others - arguably including our own - will need to focus on responsive and equitable access.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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I found the Minister's response interesting and I would have been quite comfortable delivering the opening part of it myself. I note there is just an evaluation and I take some encouragement from that because I am very much of the view, as the WHO has confirmed, that there is no evidence of any country in which a competitive insurance system has kept costs under control. While the Government, through the voice of the previous Minister for Health, anticipated that if every citizen was forced to have health insurance, providers would compete against each other, thereby driving down costs, the international evidence does not support that. As the WHO report clearly demonstrates: "The experience of insurer competition in Germany, the Netherlands and Switzerland suggests that such systems have not been effective in health care cost control." It further states: "It is questionable whether a competitive insurance system will help to improve efficiency and control costs." While the Minister is on hold pending the review, would he like to share any other insight into his current thinking and disposition towards the UHI model?

Leo Varadkar (Dublin West, Fine Gael)
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I can only give a two-part answer to that. The first part is to advise the Deputy of the plan, which we are currently enacting. First, we will extend tax-funded GP care without fees to the oldest and youngest in society. Once that is done, hopefully, by the summer, we then wish to enter contract negotiations with the Irish Medical Organisation, IMO, on extending it other groups, including other schoolchildren, chronic disease groups and so on. At the same time in parallel, we are trying to make health insurance more affordable for more people because it is good that people take out health insurance in the same way they take out other forms of insurance, whether it is life insurance, pension cover or travel insurance. It is open to debate whether a multi-payer system is the best way of keeping costs down. The best example of keeping costs down is our own system. We spend €1.5 billion less than we did seven years ago and more patients are seen. The public system is a good example of keeping costs down. I just wish we were able to do much more than we can at present.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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We are of one mind again on that. It is not only the WHO that questions this. I refer to the commentary from the Department of Public Expenditure and Reform. The Society of Actuaries in Ireland has warned that insurers could need up to €2.4 billion in additional regulatory capital to operate UHI. I attended and participated in an IMO seminar towards the end of last year in Dublin city centre. Professor Trevor Duffy and his colleagues at the helm of the organisation stated: "The system as outlined will restrict choice and lead to rapid closures of smaller health facilities throughout the country." There is strong and real concern across the board regarding the UHI approach.

I am absolutely committed to universal health care and I refer again to the opening sentences of the Minister's reply. I indicated to the previous Minister of State at the Department of Health on the announcement of the introduction of free GP care for under sixes that I was prepared to support this, which is a different position from my Fianna Fáil colleague, as it was to be part of a programmed roll-out of universal access to free GP care. Will the Minister undertake to ensure there is not an inordinate time lapse between the introduction of the roll-out to the under sixes and over 70s and the roll-out to the rest of the population? That would only perpetuate inequality and a double standard within the system. We need a speedy move towards the universal roll-out of free GP care. Will the Minister please give a clarification?

Leo Varadkar (Dublin West, Fine Gael)
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Universal health care is a group term that can mean many different things. It can be a fully tax-funded system like the British National Health Service, a system with a mix of co-payments, a system that involves compulsory health insurance using a social insurance model or a competitive compulsory private insurance model. There are many different ways to achieve universal health care. Looking across different jurisdictions and countries, one cannot say definitively that one model is best. I do not buy that. There are pluses and minuses to all models. There is the option of a mix of models and the right model has to fit the right country because countries are different culturally and we must bear that in mind.

The major delay in providing GP access without fees to the under sixes has been the time it has taken to come to an agreement with family doctors, but it was worth taking the time to do that. Once that agreement is concluded and assuming GPs take up the contract in sufficient numbers, and they do not have to, we will then immediately enter negotiations on extending such access to other cohorts. Initially it will be other schoolchildren and I am particularly keen to include adults with chronic diseases as well.