Plans for one-tier health service published

White paper on universal health insurance proposes access based on need

  Director general of the HSE Tony O’Brien with Minister for Health James Reilly as details of the White Paper on universal health insurance were announced. Photograph: Eric Luke

Director general of the HSE Tony O’Brien with Minister for Health James Reilly as details of the White Paper on universal health insurance were announced. Photograph: Eric Luke

Thu, Apr 3, 2014, 07:01



More than €400 million provided annually in tax credits for health insurance and out-of-pocket medical expenses will be diverted to help fund universal health insurance, according to a Government White Paper.

Existing charges such as the €100 fee for using a hospital emergency department will remain in place for those currently liable, though reduced charges may apply for some sections of the population.

Minister for Health James Reilly said he hoped existing tax credits would continue to be available to the health system after universal insurance (UHI) was introduced in 2019. But he admitted that this was a budgetary decision for the Minister for Finance to take.

The Government yesterday unveiled its plans to create a one-tier health system, supported by UHI, with access based on need rather than ability to pay. The plans are contained in a White Paper outlined by Taoiseach Enda Kenny and senior Ministers.


‘Once in a generation’
Mr Kenny and Tánaiste Eamon Gilmore described the document as a “once in a generation opportunity” to rebuild a health service that was not fit for purpose.

Dr Reilly claimed the plans amounted to the biggest reform of the health system in the history of the State.

The proposals received a mixed reception, with Fianna Fáil and Sinn Féin critical of a lack of costings in the documents.

The Irish College of GPs welcomed moves to improve equality of access to health services because the existing system was “inherently inequitable”. However, it said that to be effective, any new model must improve access and health outcomes for all, as well as being affordable for the State and for individuals.

Under the proposals, universal health insurance would be compulsory for everyone, with the State paying or subsidising the cost of premiums for most people. The White Paper outlines the key elements of the new system and how it will work. It also examines the future basket of services to be included in the new system, as well as funding mechanisms.


‘Unfair and inefficient’
Dr Reilly said the existing two-tier system was not working. “It’s unfair, unaffordable and inefficient. Without change, taxes will need to go up or services will have to be cut.”

The Government was determined that State spending on healthcare under UHI would not exceed existing spending, he emphasised. Specific measures would be introduced to control costs including, if necessary, capping of the profits and claims expenditure of insurers.

The public is being invited to make submission to the Department of Health on the proposals before the end of May, and Dr Reilly plans to speak at a series of regional meetings as part of the consultation process.

Under UHI, everyone will have equal access to a standard package of services. Health insurers will not be allowed to sell products that provide faster access to these services.

Dr Reilly said that if patients wanted “cordon bleu cooking or five-star accommodation” while in hospital they would have to pay for it themselves.

UHI is not due to be finalised until 2019, so final implementation will be a matter for the next government.