HAS THE time come to adopt a universal healthcare model in the Republic? According to the health manifestos of Fine Gael and Labour, the two parties most likely to form the next government, the answer is yes. Universal health insurance is the vehicle by which both parties maintain they can transform the health service.
Both claim it will end the current two-tier system which confers an advantage on those who can pay for treatment. A major selling point of a new system is an undertaking that medical care will be prioritised by need rather than ability to pay.
Despite a common aim, there are differences in the parties’ approaches. Fine Gael proposes scrapping the Health Service Executive (HSE) while Labour says it will devolve some of its functions; for example the HSE’s purchasing functions will be merged with the National Treatment Purchase Fund. Both manifestos commit to a major expansion of primary care: free GP care will be phased in over four years by Labour while Fine Gael says free family doctor services will be “fully bedded in during the second term of a Fine Gael government”.
Labour says its primary-care proposals will cost €490 million and will be paid for, in part, by savings on the national drugs budget and by a significant cut in the salaries of hospital consultants. Fine Gael says that money will follow the patient which it claims will increase the productivity of hospitals by between 5 and 10 per cent.
Fianna Fáil, meanwhile, says the HSE is a work in progress and should be given 10 years “to allow its benefits to flow”. It opposes the abolition of prescription charges and says additional medical assessment units will help ease the problem of excessive waiting times in emergency departments. However in an area long associated with former PD leader Mary Harney, Fianna Fáil’s election plan has been curiously short on specific health policy – though further details are promised.
A report from Dublin City University – Implementing Social Health Insurance in Ireland – provides an independent analysis and endorsement of universal health insurance. “Care needs to be patient centred, not determined by the needs of the institutions. Access to care must not depend on patients’ resources. A system which places a high priority on equity and social solidarity can be built and can be delivered within the existing budget. Such a system must have accountability, visibility of outcomes, resources and activity,” the report states.
In terms of practical changes, it questions whether this State needs more than one health insurance company to implement a new system. The report correctly points to the need for a much tougher regulatory regime if equity and accountability are to underpin a universal health insurance model. Given recent decisions by the Voluntary Health Insurance and Aviva, it is clear a workable method of risk equalisation must be central to any plan.
Fixing the health system will require the lifetime of the next government and beyond. But after years of promises, the electorate will be sceptical that the current inequity can be resolved in a cost-effective manner.