Reilly to ban hospital queue-jumping under health insurance plan
But patients can still pay out of own pockets to get treatment
Published 25/02/2014 | 02:30
FAMILIES will not be able to jump queues for medical treatment by paying extra under Health Minister James Reilly's radical health insurance plan.
The reform will have massive implications for the two million people who currently hold private health cover.
Insurance companies will be specifically banned from offering quicker access to hospitals for standard treatments – though they will still be able to offer other benefits such as private rooms.
Regardless of the restrictions that may be placed on companies, it will remain possible for patients to pay upfront out of their own pockets to see a specialist or have an operation if they have fears for their health.
The Universal Health Insurance (UHI) plan, which the minister hopes to have implemented in five years' time, will ensure everyone gets the same basic package of benefits.
The aim is to end the two-tier health service, where public patients wait longer than private insurance holders for treatment.
The core principle of UHI is healthcare being equally available to each member of society and treatment based solely on medical need, not income. Under the new system, private health insurance companies like the VHI will continue to trade and are likely to have an increase in the number of customers as everyone will have to acquire some form of cover.
Those who can't afford the premium will have it paid for fully or be heavily subsidised by the State.
Dr Reilly estimated yesterday that the 40pc of the population that holds a medical card will get their health insurance paid in full, with another 30pc getting a heavy subsidy.
But in a complete break from the current two-tier system, which allows private policy holders fast access to specialists and treatments, the new system will specifically forbid queue-jumping – even if you pay more.
The change will mean the 2,052,000 people – roughly half the population – who hold health insurance will no longer have the edge over everybody else in getting treatment faster.
UHI will cover basic GP and acute hospital needs and some people may wish to obtain cover for services outside of that standard package of care.
But paying more for 'Supplementary Health Insurance' won't grant quicker access to treatment.
In explaining how UHI works specifically, the government document says: "No insurer may sell a supplementary health insurance policy conferring faster access to services covered by the standard package of care."
The reference to preventing faster access is actually contained twice in the document as it also says it won't be allowed under the basic package under the "principle of social solidarity".
"Neither insurers nor providers operating within the UHI system will be allowed to sell faster access to services covered by the UHI standard package of care."
The specific services to be covered by UHI have yet to be determined. The minister plans for the public to be consulted on what to be included.
However, the document does list the components of a "preferred policy option" for inclusion under UHI, as follows:
* Universal primary care, including core GP and community nurse services and the maternity and infant care scheme.
* Chronic disease and case management for those who meet specific critical criteria.
* Rehabilitative care, for a period not exceeding 12 months.
* Acute hospital care, including all inpatient, daycare and outpatient care.
* Acute mental health care, including acute mental health services provided by community mental health teams, in outpatient clinics, day hospitals, day centres and acute inpatient setting for a period not exceeding 12 months.
* Step-down care, provided in a residential care setting or in a person's home for a defined period of time.
The change-over to UHI to end the two-tier system of access is the agreed policy of the Coalition.
Fine Gael and the Labour Party both campaigned for the policy and it is included in the Programme for Government.
Labour was making the case for UHI for almost a decade before Fine Gael came on board.
Dr Reilly's draft of the consultation document, known as a White Paper, was discussed by ministers last night and is due to be published in the coming weeks.
The paper has come under fire for lacking detail on the cost of UHI, with the Department of Finance and Department of Public Expenditure expressing concern about the financial implications.
Dr Reilly has sought to assuage these concerns by saying there will be a cap on the amount of money to be spent by the State, which will be linked to national income.
Nonetheless, the document contains no specifics on the costs associated with the switch to UHI – either to the public or the Exchequer.