Universal health insurance: what is it all about?

What is universal health insurance (UHI)?

UHI is the Government’s big idea to totally transform the way the Irish health service is structured and funded.

It would aim to eliminate the current two-tier system of public and private medicine and to end the practice of queue-jumping for treatment by people who can afford to pay or who have private health insurance.

The plan is very controversial and already has been strongly criticised from within Government on cost grounds.

It could prove politically explosive if it is seen to remove long-cherished benefits of private health insurance from the middle classes. The Opposition has already branded the proposals drawn up by Minister for Health James Reilly as simply another tax hike.

How would it work?

In essence everyone would be a private patient. It would be mandatory for all to have cover for a basic package of services - known as a basket - from one of a number of different insurers.

The State would pay the premium for the lowest income groups and provide subsidies for others. People who refused to take out cover would have it provided for them, with the cost deducted at source from their earnings or benefits.

What would be covered?

The standard policy would cover a set range of services, to be determined definitively following a comprehensive public consultation process.

However, the draft of the Government’s new white paper on the issue proposed a “preferred” basket of services which could be covered in the standard package. These include universal primary care, including core GP and community nurse services and the maternity and infant care scheme.

Acute hospital care - including all inpatient, day case and outpatient care - would be covered, as would chronic disease and care management for those who met specific clinical criteria.

The “preferred”package would also cover acute mental healthcare, including those services provided by community mental health teams in outpatient clinics, day hospitals, day centres and acute in-patient facilities, for not more than 12 months.

Rehabilitative care would also be included for a period not exceeding a year, while step-down care in a residential setting or a patient’s home would be covered for a maximum of two weeks.

What about areas that fall outside the standard basket?

Under the draft white paper, the State would also pay for other elements of healthcare not included in the standard package. These would include immunisations, screening services, ambulance services and hospital emergency department care. The State would also pay for long-term residential care.

Dr Reilly’s proposals would permit people to take out supplementary health insurance to cover areas not included in the standard package. This would include private rooms in hospitals.

However, for the first time, this supplementary insurance would be provided on a risk-related basis rather than on a community-rated basis, where everyone pays the same for identical products, regardless of age.

This could see the cost escalate considerably for older people.

Will drug costs be covered?

Under the Government proposals, pharmaceuticals (subject to co-payment) would be included either as part of the standard UHI package or through a separate eligibility scheme replacing the current medical card scheme and drug payment scheme will be considered.

The Government has said it wanted to continue to cover the drug costs of the lowest income groups, as currently applies.

What will the cost be?

The cost of a standard basket of cover will not be known until there is clarity about precisely what services will be included in it.

However, the Department of Public Expenditure and Reform estimated in a letter to the Department of Health that it could cost over €1,600.

This was seized on by the Opposition, even though the figure is strongly disputed by the Department of Health.

What were the concerns about the plan within Government?

The Department of Public Expenditure and Reform was extremely concerned the the UHI plan could be unaffordable. It warned dramatically that the measure could threaten the financial stability of the State. This was strongly rejected by the Department of Health.

On foot of a Government decision this week, backing for UHI was conditional on the new scheme not costing more than the existing health system which it would replace when it comes into force in 2019.

What will happen next?

There will be a widespread consultation process involving both the general public and health service stakeholders.

The Oireachtas health committee will hold public hearings, while there will also be a commission established to produce options for the composition of the standard basket.

Dr Reilly will next year produce proposals for the standard basket of services to the Cabinet.

The Government would also have to decide at a later date on the level of subsidies to be provided and the thresholds at which they would apply.