Chronic disease care ‘should be free’ under universal insurance – report

Health should be seen as ‘a state of wellbeing, not merely absence of disease’

The MRI room of the radiology department at  the Mater hospital in Dublin. Photograph: Bryan O’Brien.

The MRI room of the radiology department at the Mater hospital in Dublin. Photograph: Bryan O’Brien.


Care of chronic conditions should be among the services to be provided free for everyone under universal health insurance (UHI), but dental and ophthalmic services should not be included in the basic package, a Department of Health report suggests.

The policy paper proposes the Government adopt a series of “overarching principles” to ensure the basket of services under UHI is aligned with national health policy goals.

The Government should recognise the right of the Irish people to the enjoyment of the “highest possible attainable standard of physical and mental health”. “To support this, the Government will prescribe in law the right and obligation of every person . . . to universal coverage for a comprehensive basket of health services.”

The Government should recognise health as a state of wellbeing and “not merely the absence of disease and infirmity” and acknowledge the central role of the health service in improving the health and wellbeing of people, the paper on designing the future health basket says.

The principles stress the importance of primary care and the delivery of care at the lowest level of complexity that is “safe, timely, efficient and as close to home as possible”.

The paper outlines a “preferred” composition of the basket of services, to include universal primary care, chronic disease management for those who meet specific clinical criteria and acute hospital care. Acute mental health care, rehabilitation services for up to 12 months and step-down care in a person’s home for a defined period would also be included.

Dental, ophthalmic and aural services might be excluded from universal coverage, but would continue to be provided on a limited basis to those below a certain income threshold. Among the other areas that would be excluded are immunisation and screening services and maternity grants.

The issue of whether to include drug costs in the standard package should be considered, the report says, but it notes that this is likely to have a significant impact on the cost of UHI premiums.

Hospital inpatient, outpatient and day-case care, including cancer care, would be included but the emergency service would be run separately on current lines.

The actual composition of the basket of services will be decided following consultation but the Department’s policy paper is likely to frame the debate.

The report says the State should provide asylum seekers with “cover of last resort” for the period during which an application for refugee status is being considered. Prisoner health would remain the responsibility of the Prison Service, and members of the Defence Forces would be required to obtain health insurance cover on the same basis as the rest of the population. However, in line with current practice, some services would be provided when members are on active duty.

The paper also outlines a “basic” package which omits chronic disease care and stepdown care from the basket of services.

A separate background paper on funding options for UHI examines the use of payroll taxes such as PRSI, “ear-marked” taxes such as a sugar tax and general taxation to fund the new scheme.

It finds that general taxation better meets criteria such as equity, efficiency and sustainability, as well as causing less disruption than new forms of tax.