A government divided over critical reforms on health insurance and GP care


A system of universal health insurance (UHI), where medical need will ensure access to early medical care, was one of the major reforms promised by the Government and Minister for Health James Reilly. Because of its complexity, the project was expected to take up to 10 years. Following a draft White Paper however, issues of cost and inadequate consultation have generated sharp disagreements between the Coalition parties.

There is more than a hint of unfinished business about the exchanges between the departments of Health and of Public Expenditure and Reform. Before the last budget, Minister Brendan Howlin refused to accept Department of Health financial projections insisting further savings were required. Eventually, it was agreed additional cuts would be made and that representatives from the departments of the Taoiseach, Health and Public Expenditure and the HSE would oversee the process. It didn’t go particularly well.

In December, a draft White Paper dealing with universal health insurance was circulated by Dr Reilly. Labour Party Ministers of State at Health Alex White and Kathleen Lynch felt aggrieved because of a lack of consultation before the document was drafted. It was not the first time Dr Reilly had adopted a unilateral approach. The response by Mr Howlin’s department not only challenged the affordability of what Dr Reilly intended to do but took the unusual step of suggesting likely consumer costs. That, in turn, brought accusations of exaggeration, poor quality analysis and the use of “fantasy figures” by the Department of Health.

What is missing from these exchanges is clarity or any degree of certainty. The Department of Health finds it impossible to estimate costs until a decision has been taken on what basic services will be covered under UHI. Negotiations in that regard are under way with insurance companies. The Labour Party is concerned about the pivotal role of the insurance industry and wants the UHI policy and its likely costs to be rigorously analysed before commitments are made. The issue of nominal charges also crept back into the debate when Mr White suggested a GP attendance fee for children under six was possible. Dr Reilly had rejected that approach. Such bickering does nothing to reassure the public that it will benefit from an improved health service under UHI.

A failure to engage in advance consultations on a range of significant medical reforms has been a weakness in the political style of Minister Reilly. The UHI project, he himself accepts, will involve a transformation of the existing system. His robust approach has caused unnecessarily sharp disagreements with ministerial colleagues, medical practitioners, service providers and the pharmaceutical industry. A less assertive attitude might be more effective.