Debating health coverage


The response of Minister for Health Dr James Reilly to criticism that he was proceeding too rapidly with plans to implement a system of universal health insurance (UHI) must be welcomed. This week’s White Paper includes many elements that will encourage debate and facilitate public consultation on the changes to the health service envisaged under UHI. Whatever modifications emerge, the implementation of a final package will be a major challenge. Not least is the need for a specific budget for change. If the Government has recognised the need to provide a change budget of €150 million for the setting up of Irish Water, then it cannot expect such sweeping reform of our health system to happen in a funding vacuum.

There is also a need to have the fundamental building blocks of a functioning health service in place to safely carry the load of transition. Unfortunately the overall effect of stripping some €3 billion from the health budget in a relatively short space of time has damaged what was there; there is a specific concern over the future viability of general practice following a significant stripping of resources from the sector.

The Minister would do well to define the exact elements to be included in the “basket of services” which health insurers will be obliged to supply as a minimum package to all citizens. Concerns about the viability of community rating under UHI must be addressed. And those who currently pay for private health insurance will need to be convinced that premiums will remain relatively stable even though the companies providing such insurance will be driven by a need to make a profit.

In some ways it is unfortunate that Dr Reilly and his advisers did not present their proposal as universal health coverage rather than universal health insurance. The egalitarian motive of a single-tier health system is an honourable one; what is lacking at present is a widespread belief that this is the way it can be achieved.

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