Sir, – The Government’s white paper on Universal Health Insurance (UHI), published this week is fundamentally flawed.
It will place an immediate financial burden on families, and the only consultation process open to the public is restricted to deliberating on what this "competing insurers" model will look like. Meanwhile, there is no consultation of any kind taking place on any other options, such as those recommended in Dr Jane Pillinger's 2012 report The Future of Healthcare in Ireland .
That report recommended that the competing insurers model, as proposed by the Minister, should not be adopted before all the options have been evaluated in terms of quality, equity, access to services and medium and long term value for money. The report was ignored by the Minister.
Families will be required by law to have health insurance, but there is a real risk that this will be an impossible financial burden from the very start, particularly for the growing number of people without health insurance who don’t qualify for a medical card.
This group will be required to purchase health insurance for every member of their family. While the Dutch insurance model provided the Minister with his initial inspiration for this UHI scheme, it should be noted that children are actually insured for free under the Dutch model.
The question of cost remains, but it appears that no evaluation of any other funding model has been undertaken. We have been trying to get the message across to the Minister that other options need to be considered, such as the “single-payer” social insurance model used in France, Germany and Nordic countries.
Apart from a cursory late briefing on the day of publication, where questions were not invited from trade unions or patient groups, there has been no engagement with the Minister on these issues.
The experience in other jurisdictions which have similar models of competing insurers, has been a continuing rise in the price of compulsory insurance, coupled with increasing restrictions on the health services covered. They have also experienced rising readmission rates as more people experience complications after they’ve been discharged. This can be attributed to the financial incentives to discharge patients early.
The Minister’s estimate of €900 per individual seems almost optimistic, but if this model is established, the costs are likely to continue to rise. The Minister has also boasted that the scheme will ensure no additional cost burden to the State, which will mean that the only means of raising extra revenue will be through individual insurance premiums.
Finally, if we really want to get the measure of where this scheme is going, it is telling that the €100 charge for emergency departments will remain in place. Yours, etc,
LOUISE O’DONNELL,
National secretary,
Health & Welfare division
IMPACT,
Nerney’s Court,
Dublin 1
Sir, – At present everyone in the State is entitled to free treatment in a public hospital paid for by our taxes.
Under the new proposal, it seems, everyone will be entitled to free treatment in a public hospital but we must pay for private health insurance as well as paying our taxes to fund it. The difference will be that there will be no option for some to go to private hospitals as happens at present, so the whole population will use the public system, which is unable to cope with the numbers currently using it. Sounds like a lose-lose situation to me. Yours, etc,
AVRIL HEDDERMAN,
Priory Grove,
Stillorgan,
Co Dublin
