Friday 21 October 2016

Under-sixes scheme will work - but free GP care for all is a long way off

Published 17/06/2015 | 02:30

Health Minister Leo Varadkar with Kiya O’Connor (3) from Macken Street, Dublin, at the launch of the online registration system for the new free GP care on Pearse Street.
Photo: Damien Eagers
Health Minister Leo Varadkar with Kiya O’Connor (3) from Macken Street, Dublin, at the launch of the online registration system for the new free GP care on Pearse Street. Photo: Damien Eagers

It is very hard to name a moment in the history of the Irish State when significant public system change was brought in by vested interests. It is even harder to recall any time when a majority of doctors in Ireland embraced positive health system reform upon its introduction.

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By yesterday afternoon, 20,000 children were registered to participate in the free GP care scheme and 65pc of GPs had signed up to the scheme. Reaching a critical mass of two-thirds of GPs is a tipping point. There is no turning back now.

From July 1, all children under six years of age in Ireland will have access to GP care without charge. This will mean that parents of children who delayed or did not go to the GP because of the high cost of GP care can now go and go at an earlier stage.

Doctors are genuinely concerned about the impact free GP care will have on general practice in Ireland. They say they will be overwhelmed by GP visits, they will not have time to see patients, that it will take days to get an appointment and that they will have to refer people to hospital unnecessarily.

There may well be some unintended consequences of this policy change but the essence of it is that sick children who currently do not access timely care will now do so. These are often children in lower-income working households whose families have been hit at every turn by austerity.

The move will increase the numbers presenting for GP visits but it is unlikely to be the end of GP care as we know it. Most six-years-old are healthy. Most parents have the sense to only bring their children to the GP when they are sick. International literature shows that extending coverage such as this results in higher health service usage but then it levels off soon after, albeit at a higher level. But the sky will not fall in on general practice.

There are some problem areas where there is low GP uptake to the scheme, including south Tipperary, Louth and west Cork. But vast swathes of the country have over 70pc of GPs ready to deliver free GP care to our youngest children.

The National Association of GPs (NAGP), which claims over 1,200 GP members, is the main opposition to the introduction of the free GP care for children.

Two months ago, they predicted that 80pc of GPs would not sign up to the scheme.

Yesterday, the NAGP published an "independent analysis" of the scheme which apparently assesses its the impact, concluding that free GP care for under-sixes was purely a PR exercise. The report is not on the NAGP's website. At the time of writing yesterday evening, the NAGP was unable to make the report available to the Irish Independent.

The NAGP is asking GPs to donate €1,000 to a "fighting fund" to legally oppose the introduction of the free GP care. So far it has raised €100,000. Its case is due before the High Court tomorrow.

This Government committed to free GP care for every citizen before the next election and to the introduction of universal health insurance in a second term.

But the Department of Health is unable to say what will be the next steps of introducing free GP care for all, apart from extending it to all over 70-year-olds by August. Last year's Statement for Government Priorities said the next phases would be 6-11-year-olds and then 12-17-year-olds. Government will give no time commitment on this.

The ESRI was commissioned by the Department of Health to do some detailed costings on universal health insurance.

These were promised in the first quarter of this year. They are completed but have not been published.

When asked why not, a spokesperson for Health Minister Leo Varadkar said that "work is continuing involving the ESRI, HIA (Health Insurance Authority) and KPMG… this is a huge piece of work which has generated the need for further research." He also clarified that the Department of Health has "asked the researchers to look at costing different degrees of cover for universal health insurance (UHI), such as confining UHI to hospital care only, and not including drugs or primary care." They have also asked "the researchers to look at other models of UHI such as single payer insurance, as well as a model funded fully through taxation using social insurance."

This is government-speak confirmation that the James Reilly model proposed in the 2014 White Paper on Universal Health Insurance of competing private health insurers is long abandoned. This is not a bad thing, given how flawed the model was in the first place.

However, it starkly exposes how two main health promises in the 2011 Programme for Government - of free GP care for all and universal health insurance - will not be delivered.

What is now of interest is if and how the two Government parties will pursue free GP care for all and universal health in the run-up to election 2016.

Irish Independent

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