OUR TWO-TIER health service is a dysfunctional, inequitable mess, and the Government has promised to replace it with a universal health insurance system.
As a two-term project, community treatment centres, improved hospital care and free GP services will take precedence. Risk-equalisation legislation will then promote a more effective insurance market and usher in universal care based on medical need. After nine months in office, however, an expert advisory group on the issue has not been appointed and a Green Paper is awaited.
Successive government failures involving health and insurance systems offer dire warnings of the need to get things right on this occasion. Open public debate and proper financial evaluations should take place before decisions are made. This takes on a particular urgency because of plans by Minister for Health James Reilly to acquire Quinn Healthcare and merge it with the VHI. The client base of both companies would then be split to equalise age profiles before their onward sale to the private sector. The cost of this exercise has been estimated at about €500 million and, given that at least one of the companies is loss-making, their sale could be problematical. Buying Quinn Healthcare, which has been placed in administration, is an interesting idea. But merging it with the VHI before creating two equal companies for profitable sale represents a daunting risk for a cash-strapped Government. Walking away will also involve costs. The last government’s failure to adequately capitalise the VHI brought a judgment costing €220 million from the European Court of Justice and a threat of fines from the European Commission. Quinn Healthcare also needs capital. When those charges are stripped out, the net cost of the exercise could be less than €150 million.
The Minister has taken the Dutch health system as his model. There is a grand strategy involving the encouragement of medical insurance companies to compete for business and play a major role in administering the health services here. But, before the Minister tries to implement it, the promised expert advisory group should be consulted and a Green Paper should be published. That is the least the public deserves.
Vested medical and commercial interests are likely to resist such changes. They have a great deal to lose. What has emerged in Ireland, because of medical pressures and government policy, amounts to a queue-jumping system where those with insurance and private means receive priority treatment. It is both expensive and inefficient, designed around the needs of service suppliers and the better off. On the insurance side, government efforts to open up the market were inadequate. Promised community rating and risk equalisation measures didn’t work. As State costs and charges in public hospitals rose, insurance companies reduced their medical cover but dramatically increased their premiums. A stage has been reached where buying Quinn Healthcare to protect older VHI customers and develop a universal health insurance system could make sense.