Health deal a step in the right direction
Published 11/04/2015 | 02:30
Delivering GP care without charge to under sixes and over 70-year-olds by the summer is a much-needed political win for this Government.
Of course, the Government has gone about it in a ham-fisted way. Initially, it promised 'free GP care' to those on the Long Term Illness Scheme by March 2012, to those in the High Tech Drug scheme by March 2013 and to the whole population by 2016. It was an entirely sensible plan to start with the sickest. However, none of these promises will be met.
Instead, apparently due to 'legislative difficulties', it made what should be a good news story a messy one by choosing to go for the youngest and the oldest instead of the sickest. But it is a good news story all the same.
Ireland is unique in a European context in that it does not provide universal access to primary care. Being able to go to a GP without having to pay for it is the most minimal form of universalism.
GP care without charge will mean that people who do not go to the GP due to the high cost will now be able to go.
It will be particularly beneficial for people on low income who do not qualify for a medical or GP visit card. Many of these are working families with young children.
While there is dubious evidence on the benefits of 'wellness' checks, giving GPs a carrot to promote children's health through monitoring and tackling obesity can only be seen as progress for Ireland's public health.
Perhaps the most positive element of this deal is the new 'Diabetic Cycle of Care contract' for those with a medical or GP visit card and the enhanced asthma care for children.
The agreement between the Irish Medical Organisation (IMO), the HSE and the Department of Health is also significant, as it acknowledges workforce issues.
Allowing GPs to work until 72 years of age and introducing flexible, shared contracts are the first of much-needed measures to tackle our ageing GP workforce and bring more women into it. It also recognises that GP care without charge cannot be delivered overnight, as there are not enough doctors and nurses in primary care to do it right now.
The National Association of GPs (NAGP) has been critical of the move, and said it was not ethical or moral to give free GP visits to under sixes and deny medical cards to sick and disabled seven- or eight-year-olds. This is completely disingenuous.
First, the 2011 Programme for Government never committed to medical cards for all. It promised that "Universal Primary Care will remove fees for GP care and will be introduced within the Government's first term in office". If the NAGP want medical cards for all then it can campaign for that in the run up to election 2016.
Second, comparing free GP care to medical cards is like comparing apples with watermelons - they are simply not comparable and it is not an either-or situation. Of course, very sick and disabled people should have a medical card in order to access essential care without cost, but it is very difficult to do that under the current rules.
The 1970 Health Act still determines eligibility for medical cards and they are largely allocated on the basis of low income. The Government tried changing this, but Prof Frank Keane's 'Report of the Expert Panel on Medical Need for Medical Card Eligibility' quite clearly concluded it was not possible to allocate cards on the basis of medical condition.
So now the Government is trying to find a way of allocating on the basis of medical need. Some delivery on this before the next election would be a very positive step and would make the further extension of GP care without charge more palatable.
Third, it is not 'free'. Every citizen is paying for GP care without charge through direct and indirect taxes. The fatuous question is trotted out - why give free GP care to millionaires when sick people don't have medical cards? If millionaires (not that there are many of them) can send their children to primary schools without charge, then why can't they bring their young children to GPs without charge? They are paying for it handsomely through the taxation system.
As Minister for Health Leo Varadkar stated when the Frank Keane report was published: "the more that I have studied the issue of eligibility for medical cards, the more I have become convinced that the only solution is universal health care. No matter what means-test you apply, whether financial or medical, there will always be anomalies and there will always be people just above the threshold".
This is the very point of universal access to healthcare. It is internationally and nationally proven that charging for access to essential care and drugs deters necessary use. The only way to ensure access for all citizens is a universal healthcare system that has no cost barriers to access - paid for either through taxation or some form of social insurance.
Welsh Labour Party politician Nye Bevan famously said that the only way he managed to introduce the NHS in England was by stuffing the doctors' throats with gold.
Sceptics say that there are better ways to spend €90m in our over-stretched, under-resourced public health system.
However, if this government is really serious about shifting care out of hospitals into primary and community care then it has to start with allocating more money to general practice, primary and community care. This €90m is an essential move in the right direction and seems like very good value for public money.
The agreement announced this week is a triumph for Government and Irish citizens as it is a first, really important step towards managing chronic diseases in general practice and, in the words of Minister Varadkar, "it marks the most tangible step forward so far along the road to universal healthcare".
Every GP has the right to opt in or opt out of the new scheme. If the IMO and the NAGP are really serious about their commitments to universal healthcare, then their members should act on their word and deliver on the chronic disease management and free GP care for the youngest and oldest in society as stipulated in this week's agreement.
Sara Burke is a health policy analyst, journalist, and post-doctoral research fellow at Trinity College Dublin