Slowing down reform to ensure the right health insurance regime is in place


Universal health insurance (UHI), the major health policy initiative championed by Minister for Health Dr James Reilly, may have been successfully resuscitated in recent days. After dire warnings from the Department of Public Expenditure that UHI could cost up to €1,600 a year per person, and briefings from within Government parties that the policy was close to being unimplementable, a concerted effort has now been made to slow down the speed of reform. Coming just after Fine Gael’s ard fheis, it seems wiser heads have prevailed. Its full implementation will not now happen until 2019 though the Government must be aware that healthcare and its related insurance sector is in a parlous state at present. In such circumstances, great urgency is needed but it simply has to get it right.

Recognition of the need for greater public consultation means a citizens health assembly will be established by the end of May. And the early publication of a White Paper on UHI suggests an acceptance that the issue had rapidly turned sour for the public. Credit is due to those behind this shift in emphasis. With massive cuts in public health spending over recent budgets and regular reminders of poor patient care within the Health Service Executive, public confidence is extremely low. The pace of reform initially embarked on by Dr Reilly was too fast and too risky. A confrontational attitude to those at the health frontline has not helped. Given the need for a good start to such massive reform, the decision to adopt a “take it or leave it” approach to the contract for the provision of free care for under-6s by GPs was unwise. It resulted in less than 5 per cent of GPs indicating they would participate in the scheme.

Hence a recent memo from Minister of State for Primary Care Alex White to the Irish Medical Organisation is evidence of a new realpolitik. He noted IMO concerns that the Department of Health and the HSE may not be prepared to engage meaningfully on the issue. The Minister said he wanted to make clear that this was not the case. Acknowledging the potential barrier of competition law, he said, “it seems to me that we can work together to seek a consensus on the many important matters of mutual concern, and it is my genuine wish that we should proceed in that spirit.”

The same spirit must now be applied to UHI. The public needs to see humane plans to deal with those who because of chronic illness or lifelong disability may have difficulty making timely co-payments required under UHI. Rather than emphasis on punitive action there must be a practical acknowledgment that uninsured people may on occasion require emergency healthcare and that a special fund should be established by the State to pay their treatment costs. UHI faces a long, difficult road. The Government must continue its new approach to treatment if the ultimate goal is to be achieved.