Let the great debate begin on health cover

Personal finance expert Jill Kerby says its time to get talking about the universal health insurance plan.

Personal finance expert Jill Kerby says its time to get talking about the universal health insurance plan.

The only good thing about the 2019 deadline set by the government for the introduction of Universal Health Insurance (UHI)…is that it’s still five years away.

A lot can happen in five years and there’s no point in getting ourselves into a tizzy about a still to be determined new household expense that is still years away.

As it is, most of us are too busy focussing on how we can afford today’s health costs, like the price of a GP visit (if you don’t have a medical or GP-only card); the €100 for an A&E visit; €75 for every night spent in a public hospital (maximum 10 nights); the €144 prescription a family must pay each month before the state drug plan kicks in; the €2.50 per prescription item for medical card holders and the huge and soaring cost of private health insurance premiums – now averaging over €1,000 - for the 2.1 million PHI members.

Nevertheless, the UHI debate needs to get underway.

The Department of Health White Paper is expected out very shortly. Everything you’ve heard or read about the new insurance costing €1,600 per annum or €5 billion on top of the current €13.6 billion public health costs and the €2 billion for private insurance, is just speculation. (Reliable sources say no costings are included in the Paper.)

The real starting point for this White Paper and the ensuing debate has to be: how can a small, heavily indebted country with a seriously dysfunctional two tier health service, dominated by the Department of Health/HSE turn itself into a world-class, efficient, affordable service that produces better health outcomes for everyone?

If that is not the ultimate goal of this huge and undoubtedly expensive shake-up, then the entire exercise is going to be just another scandalous waste of money and time.

So where do we start?

How about in recognising that the current two-tier system is no longer working. The costs are out-of-control on both sides (that is, they exceed available income and resources) and the flawed, community rated private insurance model is being destroyed by the imposition of new charges, higher levies and the loss of tax relief.

The government also needs to recognise that UHI needs all stakeholders aboard to work out the best plan possible – including representatives of the 20 existing private hospitals, private GPs, consultants and others, private health insurers and critically consumers. None of these groups are on the Department of Health’s implementation group .

Rumours and speculation suggest that the plan is to bring in a UHI system that will cover a minimum contract that covers all GP, primary care and hospital costs. There will be no jumping treatment queues.

The speculation is that there may be co-payments for drugs, and that we will have to buy a supplementary policies for semi-private or private accommodation and ancillary treatments like physiotherapy, dental care and even infertility treatment.

According to healthcare expert Dermot Goode of www.healthinsurancesavings.ie this speculation is based on the Dutch UHI model, with the exception of trying to buy a private room with supplementary insurance. Enhanced accommodation does not exist in the Netherlands, main because they never operated the public/private hospital system.

A proper universally insured system here, said Goode, needs to be specific to our unique circumstances, and “is going to need taxpayer and stakeholder support from the start.”

Already, he said, there is resistance by GPs “who have not been consulted” about the introduction of medical cards for the under-6s. A properly running, efficient UHI system will not function without their wholehearted support, he suggested.

As for the rest of us, the Government needs to get the right UHI road map in place if they expect the nearly two million or so taxpayers/PHI members to subsidise what appears to be as many as 1.5 million people whose incomes are reportedly too low to afford the universal insurance.

Perhaps the most difficult task for the Government will be to convince taxpayers who are neither medical cardholders nor PHI members – reckoned at about a million people - that they too will have to pay for UHI from 2019.

It has been speculated recently that the Irish state will resort to the Dutch model again and confiscate the UHI premiums directly from wages or savings of the non-compliant.

Let the debate begin. Let us start as we wish to finish.