Tuesday, 24 November 2015
Universal Health Insurance
I thank Senator Bradford for raising this issue and for giving me an opportunity to address the Seanad on this matter. I spoke on it in the Dáil last week.The Government is committed to a major programme of health reform, the aim of which is to implement universal health care in Ireland. This means timely access for everyone to effective, quality, affordable health services.
In April 2014, the White Paper on Universal Health Insurancewas published. It proposed a competitive, multi-payer model of compulsory universal health insurance as the means to achieve universal health care. Following its publication, the Department of Health initiated a major costing project, involving the ESRI, the Health Insurance Authority and others, to examine the cost implications of a change to the model of UHI proposed in the White Paper. This initial costing project has now been completed and the underlying reports by the ESRI and KPMG, on behalf of the Health Insurance Authority, were published last week.
The analysis finds that the introduction of the White Paper model of UHI is likely to increase health care expenditure, with additional costs arising as a result of addressing unmet need for health care and the high transactional costs of operating in an insured environment.The high Exchequer subsidies and individual premiums that would be required to fund this model are not acceptable either now and nor would they be at any time in the future. The reports essentially support the Government decision not to rush the implementation of universal health insurance in advance of this costing exercise. It is also clear that there is a need for further research and cost modelling on the best means to achieve universal health care. I have decided, therefore, that the next phases in the costing exercise will include a deeper exploration of meeting the cost of unmet need for health care and a more detailed comparative analysis of relative costs and benefits of alternative funding models, both single and multi-payer.
The introduction of universal health care represents the most fundamental change in our health service in the history of the State. We have already introduced the first phases, with GP care without fees or a means test for the youngest and oldest in our society. The latter came into effect during summer. It is vital that before deciding on which funding model to adopt, key building blocks are put in place to provide a solid foundation for universal health care. I have already signalled my commitment to pushing ahead with these key important reforms.
The reforms include putting in place sufficient capacity to satisfy unmet demand in terms of specialists, critical care beds and other infrastructure because a system without adequate capacity will always result in waiting lists and rationing, no matter how it is structured. We need to strengthen primary and social care, which includes the further phased extension of GP care without fees and the improved management of chronic disease. We need to put in place reformed structures to replace the HSE, including hospital groups and community health care organisations. These are now established on an administrative basis, although we still have to appoint all the boards of the hospital groups and put them on a statutory footing. We need to implement financial reforms, including a more efficient activity-based funding model. Some people prefer to term this "money following the patient". The conversion year for the model is 2016. We also need to implement the Healthy Ireland programme and drive forward new patient safety measures. This will reduce the cost of health care in the long term and improve public health.
As well as representing major milestones on the road to universal health care, these are important initiatives in their own right with the potential to drive performance improvement and deliver significant benefits in terms of timely access to high quality health care for all the people of Ireland.