Experts urge subsidised GP care for patients

SUBSIDISED GP care for all patients registered with a doctor has been recommended by an independent expert group in a report launched by Minister for Health Mary Harney yesterday.

Four types of primary care cards would replace existing schemes, including medical and GP-visit cards, with a system of graduated subsidies for prescription drug charges and doctor visits.

The expert group on resource allocation and financing in the health sector was chaired by Prof Frances Ruane, director of the Economic and Social Research Institute (ESRI).

The report advocates “incentivising the shift from acute hospital to more appropriate primary-care settings” and the end of the “over-reliance on hospitals as a source of services” for patients.

The cost of subsidising GP and prescription medicines was estimated to be €513 million per year, if the Government implemented the proposed system.

Citizens with a “standard” primary care card, covering all individuals registered with a GP, would pay €40 per GP visit and 80 per cent of their drug fees.

Households with incomes which are 50 per cent of the national average and those with high risk of chronic illness would receive “standard plus” cards. They would pay €30 to visit the GP and have to cover 60 per cent of their drug costs.

“Enhanced” cards would be similar to the current GP-visit cards. They would be given to households with incomes that are 40 per cent of the national average and those with chronic illness needing treatment. Such cardholders would pay 40 per cent of their drug fees and €20 to see the doctor.

Meanwhile, “comprehensive” cards, similar to the existing medical card, would give patients access to healthcare services without a fee. The cards would be available to households with incomes in the lowest 30 per cent and those in the “High Tech” drug scheme.

Suggested funding sources included efficiency savings in the hospital sector, with the expert group claiming €300 million could be saved if all acute public hospitals brought their performance into line with that of their most efficient national peers.

A second suggested source would be to remove some healthcare-related tax reliefs that are in place and replace them with “more focused subsidies”.

One of the report’s recommendations, that tax reliefs on medical expenses and private insurance be replaced with more targeted subsidies, was not supported by the Department of Finance.

The report said a review of the GP contract was overdue: “It was designed in a different time and is no longer fit for purpose,” it stated. The expert group highlighted “some very poor” primary and community service facilities, too few single rooms in hospitals as well as inadequate information systems.

A shortage of certain types of public acute hospital capacity has resulted in unsustainably high occupancy rates, the report said.

In contrast to the public sector, the report found a surplus of some types of private hospital space. Co-located hospitals “may not come on stream” in the present economic climate.

The report called for the development of clearer “roles, responsibilities and accountability” within the Health Service Executive (HSE), so that its resources can be managed more effectively.

The way in which resources are allocated can “actively encourage care in less appropriate settings”, the report said.

The report recommended the role of the National Treatment Purchase Fund (NTPF) be “mainstreamed” within the HSE and that the functions of the NTPF in relation to reducing waiting lists should be “phased out” over a three-year period from 2012.

“While there are aspirations for the ‘money to follow the patient’ . . . in the health budget, there is no structure in which this can take place and the potential for individualised care solutions in many parts of the healthcare system have yet to be developed,” the report stated.

The financing of the healthcare system “lacks transparency, gives rise to serious inequities in access to care, and results in numerous anomalies in terms of incentives for users of care”. The expert group reviewed international experience and found legitimate arguments for either retaining a mainly tax-financed system or for shifting to a health insurance system.

Healthcare Remedies: Report's Recommendations

-Department of Health and HSE must enhance financial and management information systems.

-New contracts for those working in the primary care sector should be introduced. Contracts within the health and social care sector should be simplified and standardised.

-Tax reliefs on private health insurance should be phased out and the resources released for policies such as the creation of a "coherent medical card framework".

-The functions of the National Treatment Purchase Fund (NTPF) in relation to reducing waiting lists should be phased out from 2012.

-User fees in primary and community care should be lowered where they are likely to deter use.

-The Department of Health and Children should clarify the roles of different bodies in relation to regulation and oversight to ensure that procedures are in place to deal with wrongdoing.

-Proper protocols and costing for diagnostic services to be introduced. – MARY MINIHAN