What drugs do we pay for? You decide
It’s proposed that there be public consultation before deciding which drugs and treatments the State should fund, and which ones we simply can’t afford
The draft white paper on universal health insurance asks whether it is fair to share all medical costs at a societal level or if some of these costs should involve the question of personal responsibility. Photograph: Getty Images
Over the past couple of years controversy has flared on a number of occasions over whether the State should or should not pay for newly available drugs or treatments that offer major advances for patients but come at an extremely high price.
In a number of cases, the Government intervened and ensured that new drugs were made available, for example, to patients with particular types of cancer or cystic fibrosis despite the products having failed cost-effectiveness tests.
It is inevitable that patients with a particular condition along with their families and friends would argue strongly that newly developed treatments or drugs that offer greater potential should be available in the public health service.
However, on the other hand, the costs involved can be extremely high at a time of already stretched health budgets.
Last year, for example, it emerged that one cancer drug, with a price tag of around €74,000 for an 18-month course of treatment, could cost the health service about €39 million over five years to treat 130 patients.
It is generally agreed in the health service that these arguments will continue and probably intensify in the years ahead as more drugs and treatments emerge with very high costs.
Set of values
The draft white paper on universal health insurance, drawn up by the Minister for Health, James Reilly, proposes that as a society we should prepare for this eventuality and lay down a set of values that would underpin decisions in this area in the future.
Perhaps the key issue in the whole plan for universal health insurance is what should be contained in the standard health basket – the package of services for which everyone in the country will have to be insured.
The draft white paper says that decisions on the composition of the future health basket are not simple or straightforward.
“Rather, they are complex and multi-faceted, involving various technical, economic and ethical considerations.”
Above all, the draft white paper asserts, “they are deeply value-laden”.
“And, as such it is very important that the values underpinning the health basket reflect the values of the society served by that health basket.”
Establish a commission
But what are the core values of our rapidly changing society and how should they be determined as they affect healthcare?
The document says that the Government would establish a commission to engage extensively with the public before finally making recommendations to Ministers on what should be contained in the standard health basket.
It says that as part of the consultation process, the new commission would develop a “values framework” that would embrace the ethical, economic and technical issues and which would be used in assessing health services and technologies.