Sir, – In principle I can agree with Dr James Reilly's vision (Opinion, February 18th) of establishing universal health insurance (UHI). However, there are practical and implementation issues that I find worrying.
Take the proposed split into purchasers and providers of health services. Central to this is some element of competition between providers. However, all our public hospitals (including the voluntary ones) are at present State-financed, very closely monitored (as the board of St Vincent’s will testify) and their employees’ pay and conditions make them public servants all but in name. Real competition will mean allowing individual trusts to negotiate independently over all aspects of their cost structure.
Is the Department of Health ready for this? At present health insurers negotiate on prices with private hospitals, but are forbidden by ministerial edict to negotiate prices with public hospitals. I fear that the mindset of the Department of Health is totally at odds with any meaningful moves towards flexibility or competition.
Dr Reilly makes no mention of where the several billion euro of current direct State expenditure on public hospitals will go. Will there be tax cuts to offset increased premium costs of UHI? If not, will this tax revenue just go to increase public expenditure on non-health areas? To what extent will UHI deliver subsidies to lower-income clients? Will we end up with a universal system which may deliver equality – but at the unsatisfactory level of service at present enjoyed by public patients?
The track record of the Department of Health in estimating the costs of new developments does not inspire confidence. Remember the spectacular underestimate of the cost of giving medical cards to the over-70s – which was a trivially simple exercise compared with the move to UHI. – Yours, etc,
JOHN SHEEHAN,
Willbrook Lawn, Dublin 14.