Plans for one-tier health service published

White paper on universal health insurance proposes access based on need

The Government has unveiled plans to create a one-tier health system, supported by universal health insurance, with access based on need rather than ability to pay.

The plans are contained in a white paper on universal health insurance which was launched today by Taoiseach Enda Kenny and senior ministers.

Mr Kenny and Tánaiste Eamon Gilmore described the document as a “once in a generation opportunity” to build a health service that was currently not fit for purpose. Minister for Health James Reilly claimed the plans will amount to the biggest reform of the health system in the history of the State.

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.


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 blue 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.

Paul Cullen

Paul Cullen

Paul Cullen is Health Editor of The Irish Times