White Paper on Universal Health Insurance

The publication of the White Paper on universal health insurance represents the cornerstone of a move towards full implementation of the system. This move towards an all-inclusive model is reflective of the commitments made under the programme for Government that health care should be provided across the board to everyone, regardless of illness or income. I firmly believe that it is right that we do not treat public and private patients differently. The universal health insurance model moves us towards a more all-inclusive system that puts patient before purse. It is a shame, despite all of the resources made available to the health system between 1997 and 2007, that this kind of change was never enacted. It is to the credit of the current Minister for Health and the Minister of State, Deputy Alex White, that – irrespective of how one evaluates the working out of this – this is the first genuine attempt to remove the inherent discrimination that currently exists in the health system. That is to be applauded.

This White Paper gives an assurance that the universal health insurance sector will become completely transparent under the new model. It will place a requirement on all insurers to unconditionally accept and provide an individual with a health insurance policy, regardless of age, health status or other factors which could be deemed high risk. That is critical and is the central plank of the proposed policy. The demographic profile of our country has changed drastically in recent years, with an increase of 21% in the number of people aged 65 and over. According to CSO projections, this trend is set to continue, with an increase of 50% by 2026. That is why we need change now, to deal with that. The existing health system is an unfair, two-tier system and is in urgent need of replacement. According to the White Paper, the relationship between age and health care costs is central. Pharmaceutical costs incurred by 70 year olds are seven times greater than those incurred by 20 year olds and the cost of private health insurance is, on average, ten times greater for 70 year olds. One of the major barriers faced by older people when deciding to take out private health insurance is that some private insurers place a five to ten year waiting period on customers who are 65 or older before they can access the enhanced benefits for a medical condition which is either new or was evident at the time of purchasing the policy. The private health insurance market has become increasingly segmented with insurers offering tailored packages to younger people that are designed to be unattractive to older people. The new universal health insurance model will stop this practice and give everyone the luxury of choice, immediate cover and the right to be accepted by their chosen insurer. More importantly, it will give everyone the right to be charged the same premium for the same policy, regardless of age or risk profile and that is critical.

I know some are concerned that this new model will put a greater strain on hospital waiting times. Indeed, the current system has been doing that but it must be put on the record that the Minister has made a great deal of progress in tackling this. I am very proud to put on the record of the House the fact that in my own county of Cavan, hospital waiting times were reduced by 19% from the beginning to the end of 2013. Great credit is due to the management and staff of the Cavan Monaghan Hospital Group for that achievement. I was happy to hear the Minister say yesterday that he will shortly bring forward a strategy to bring waiting times in Ireland in line with European norms and that this will take place in advance of the introduction of universal health insurance. The removal of long waiting times is a central plank because the entire principle of the new policy is equity, fairness and equality of access.The White Paper makes reference to the types of service that will be included under the umbrella of the new universal health insurance system. This health basket will be a standard package model and will cover a comprehensive suite of core health services. The paper makes a commitment that the services to be included will be safe, effective and of high quality. It will include, importantly, core primary care services as well as those provided by acute hospitals and our mental health services, which is central and should be the case. In recognition of the fact that the process of establishing this basket under the eventual one-tier system will be a complex one, the Government is committed to engaging in a comprehensive public consultation process and establishing a commission to present the costings of each option to the Government. We will have costings and an effective analysis which is what public debate should be about.

I am happy that the Minister of State, Deputy White, has invited general practitioners to dialogue. I encourage both the Minister of State and the Minister himself to continue with that dialogue and to take on board the concerns of general practitioners, particularly about bureaucracy and the need for back up to deliver free medical care to children under six. I urge the Government to interact with general practitioners and to review their contract in light of their concerns because they are important front-line providers.
Under universal health insurance, there will no longer be any distinction between public and private patients. Neither insurers nor providers will be allowed to sell faster access to services in the standard universal health insurance package. That day will be gone and that is the attraction of health insurance at the moment. Last night the Minister made the point that hospital services are free and yet more than 50% of people in Ireland take out private medical insurance on an annual basis. The rationale for doing so is to get faster access to the same services which would otherwise be free of charge. This means that those who cannot afford private insurance have to wait, often indefinitely.
This is what universal health insurance will eliminate. It is what the Minister is working to achieve all the time. The current situation is simply unfair. I am happy to see that there is a system of support in place to ensure that health cover will remain affordable for everyone. It is vital that those who are in a difficult position in relation to paying will not have a problem. It is especially important for those from lower socio-economic backgrounds or on lower income as they will have their costs fully paid by the State. The Minister has made a commitment that people on low incomes who currently qualify for medical cards will not lose their core benefits. It is a concern people have but it will not happen. Regardless of whether a person pays all, some or none of the costs of universal health insurance, he or she will be able to access a standard package of health services on a fair and equitable basis to meet his or her health needs.

Under the current system, high general practitioner fees are deterring people from seeking initial treatment which might prevent serious illness from occurring. There is empirical evidence of this phenomenon, which is critical. It is therefore important to include free access to general practice care. It is an essential part of the Government’s plan, in which context the under-six provision represents a very real start. Free general practice care will mean there is a greater level of prevention and early diagnosis. It is a hugely important initiative in respect of which I hope the Minister of State, Deputy Alex White, succeeds in his negotiations. The State inclusion of free general practitioner care represents further financial assistance to those who may not be able to afford health insurance. It is expected to have a positive impact, in particular on young families with children. It is in line with the Government’s goal of reducing waiting times to ensure that everyone receives adequate care in a timely manner. It is a huge thing.

I am greatly in favour of the primary care dimension of the proposals and the delivery of services at local level. It is central to the Dutch model and in line with our substantial record of delivery of primary care centres. I have opened a number of them in my own constituency recently across a number of towns. I am delighted by the openings, of which we must have more. We must look at the rigidity of roles in the system. There are jobs being done by nurses currently that could be done by care attendants. Functions are being carried out by doctors which could be done by nurses. We need to remove rigidities and deal with orthodontic treatment, which is far too inaccessible and costly. The fundamental principle that everyone regardless of personal circumstances or income has equal access to health care, however we implement it and whatever adjustments we must make to get there, is the core guiding vision that should keep us going. It is an admirable concept and a disgrace to our country that we are only turning to it now. It is to the eternal credit of the Government that it is the first Administration to face the inequality in our health system head on. I welcome the White Paper.

Senator Joe O'Reilly representing Cavan & Monaghan 2010. | An ExSite website