Universal Healthcare Insurance
* Is there a simple explanation for universal healthcare insurance?
Essentially, it means having the entire population insured with private companies. The plan is for the State to pay the premiums for the least well-off, subsidise others and let people above a certain income pay their own. The hope is that different companies will operate here, providing competition. The insurers will then buy services from public and private hospitals for its customers. The current system of the HSE giving a block grant to a hospital to deliver patient care will end.
* Why change?
The theory is that it will be more cost effective and end the two-tier system of public and private healthcare. For instance, the insurer will pay a certain fee for a hip operation.This should lead to incentives for hospitals to do more.
* So the old divide between public and private patients will end?
That's the theory. Everyone will be insured for a basic level of care in hospital as well as for free GP visits.
* No more waiting lists and delays in seeing a specialist? Not quite. Waiting times have the potential to get longer or shorter. The population is ageing. But everyone will be waiting the same length of time.
Someone who currently has health insurance and faces minimal delay will join the same queue as everyone else – which will not be good news. Unless more hospital consultants and other staff are hired the delays will continue and may even get worse.
* If I take out supplementary insurance can I speed up access?
No, according to the draft rules. But there is nothing to stop someone paying for a doctor's appointment, a scan or operation themselves out of their own pockets if they don't want to queue.
* What is the supplementary insurance for so?
It will be mostly accommodation. The majority of us will be treated in public hospitals but if you don't want to be in a ward with eight more people and one toilet you can pay more for an en-suite private room – so this is a two-tier system of another kind.
* It will all come back to money then?
Yes. We still don't know the cost. It is still unclear how much the premium will be. €1,600 has been speculated. The State will put a cap on how much it spends so we are likely back to the old problem of demand exceeding supply.
* What are the less obvious pitfalls?
Hospitals will be under pressure to generate as much income as possible to stop going into the red. So there is a risk of conveyor belt-style care with patients being discharged early. This is already seen in Holland where the system has been in place for years. Health insurers will want to make profits so will quiz patients needing certain tests and scans. Emergency departments will not be covered.
The insurance will not cover a lot of health services outside hospital so these will still need to be funded directly through taxes. Hospitals currently pick up the pieces for many of our social problems. Will a new era mean an elderly woman who can't return home until she gets a homecare package be told to leave because she is occupying a bed and losing a hospital cash?