Enda Kenny is drawing his inspiration for a healthcare service from the Dutch model, writes AILEEN MURPHY.
AT THE recent Fine Gael Ardfheis, party leader Enda Kenny indicated that if in government Fine Gael would introduce a healthcare service based on the Dutch model. This, according to Kenny, would mean the introduction of universal health insurance for Ireland.
The Dutch healthcare system is a single healthcare system with three central features. Firstly, there is a mandate which stipulates that all residents are required to purchase at least basic health insurance from a private insurer. This basic health insurance benefit package covers primary care and pre-approved pharmaceutical products.
Secondly, consumers have a choice of health insurance plans from which to choose. Under the Health Insurance Act 2006, insurance companies must accept all applicants. Risk equalisation is in place which aims to compensate Dutch health insurers for taking on riskier insures. Thirdly, the health insurance markets are regulated at a national level.
In adopting this model in Ireland, Kenny advises that the proposed mandatory health insurance will be either partially or fully subsidised by the State. This is in contrast to the Dutch model in which individuals must purchase at least a basic insurance package from private insurance companies. Kenny’s proposal appears to suggest that it is merely the mechanism of reimbursement in the Irish system that will change.
It seems revenue will still be collected through a general taxation system and then be divided between the public through individual insurance policies or fully subsidised by the State.
In contrast, health insurance is financed in two ways in the Netherlands. One source of finance is from a flat rate premium paid by each individual directly to their own insurer.
The second source of finance is a 6.5 per cent income-based contribution made by all individuals into a national insurance pool. These accumulated funds are used to finance the risk- based premium allocations made by the state to the insurers.
The current Irish system involves an unknown proportion of taxes paid by individuals being allocated to the Department of Health and Children. This revenue is used in the Primary Care Reimbursement Services and funding of hospitals and other community and public health services through the HSE.
Through this public system all citizens are entitled to public beds in public hospitals free. More than one-third of the population is eligible to access all health services free through the General Medical Services system.
In addition, citizens may subscribe to a voluntary health insurance to cover private accommodation in public or private hospitals. It is estimated that more than 50 per cent of Irish people have voluntary health insurance despite the entitlement for the public to avail of public beds in public hospitals free of charge.
Private health insurance is sought to avoid long waiting times: access and quality are thought to be inferior for public patients in comparison to private patients.
It is not apparent what revenue collection method is going to be used to gather earmarked funds to ensure a Fine Gael-led government could provide partially or fully subsidised mandatory health insurance for all Irish citizens.
Nor is it apparent how it would be decided whose insurance would be partially subsidised or whose would be fully subsidised. If this distinction is to be made on the basis of income, it is not apparent how the proposed system would be an improvement to the current model. Such a distinction by income would appear to suggest that again access to health insurance, and thus healthcare, will be determined by willingness and ability to pay.
While the poorest will be entitled to fully subsidised insurance (similar to current GMS medical card scheme) and the rich will be able to purchase the basic insurance package, plus add-ons (as seen in the Dutch system), those in the middle will fall through the gaps again.
The success of such a proposal, therefore, would require proper planning and reform of the existing healthcare structure, not just the reimbursement mechanism. Currently the Irish State is a provider and purchaser of healthcare.
Recent trends in healthcare reform, particularly in Europe, have involved separating the role of government as the provider and purchaser of healthcare. Evidence from healthcare system reforms in Europe suggest that it is not less government that is required to “fix” a health system – but better government.
To implement healthcare reforms successfully, preparation is vital and a clear understanding of the environment must be obtained. Strategic alliances between the parties must be built and public support must be acquired.
More “homework” is required to establish how exactly “universal health cover” can be provided in Ireland.
Aileen Murphy is a lecturer in economics specialising in health economics at University College Cork