Universal health care will be cheaper and better

Opinion: The State will subsidise the less well-off and care will be delivered on the basis of need

Tue, Feb 18, 2014, 00:01

The Government has embarked upon one of the most comprehensive programmes of healthcare reform since the establishment of the UK’s National Health Service (NHS) in 1948.

We want to build a fair, efficient and high-quality system of universal health insurance (UHI) in Ireland, where all citizens are treated equally. The only way we can achieve this is through radical reform. A White Paper on UHI will be published shortly and will allow for full consultation with the public on the basket of services to be provided under UHI. I believe that people must have their say during such massive change and I encourage everyone to be involved.

Major progress has certainly been made over the last three years in improving productivity. There has been a 33 per cent decrease in the number of trolleys since 2011, a 99 per cent decline in inpatients waiting over eight months, and a 95 per cent fall in people waiting for an outpatient appointment for over a year. All of this despite a 20 per cent decrease in the health budget and a 14,000 decrease in staff numbers.

However, while further productivity improvements within the existing system must be made, it is clear we need to go further and change the way in which the whole health service works.

The programme for government commits us to merging the public and private systems into one universal service which is financed through a combination of taxes, insurance premiums and co-payments. Under UHI, every person will have insurance and the ability to choose between competing insurance companies, including the State-owned VHI.

The State will pay for or subsidise the less well-off, and care will be delivered on the basis of need rather than income. Everyone who has a medical card will retain their entitlements.


Separating purchaser from provider
It is envisaged the move to UHI will be accomplished in two stages. First, a purchaser/provider split will be established in the public health system, where separate organisations are responsible for purchasing and providing services for patients.

At the moment, the Health Service Executive performs both functions, reducing both efficiency and accountability. Legislation this year will replace the HSE with a Healthcare Commissioning Agency, which will act as purchaser of services in the health system. Legislation next year will create new, autonomous provider organisations including a series of hospital trusts. A new “Money Follows the Patient” financing system will pay providers on the basis of their outcomes and performance.

Second, full UHI will be introduced during the next Government’s term of office. Some of the functions of the HCA will be taken over by the insurance companies, who will act as agents of the State. This system of managed competition, which underpins many UHI systems across the globe, recognises that monopolies in health tend to be inefficient and inflexible.

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