Sunday 18 August 2019

Any dreams of health utopia are finally dashed

Minister for Health Leo Varadkar
Minister for Health Leo Varadkar
Eilish O'Regan

Eilish O'Regan

A family of two adults and two children can currently get a good private health insurance package for an estimated €2,500. However, under the system of universal health insurance, proposed by the Government, an individual could be paying an annual premium of around €2,228 to cover GP visits, hospital care and mental healthcare.

And for 42pc of the population, the bad news is that there would be no subsidy to help carry the cost of this mandatory insurance.

Those stark figures alone are enough to make the pre-election utopian dream we were sold of health equality for all turn sour.

The Exchequer cost to shore up this system - which would be free or subsidised for 58pc of the population - would be massive, ranging from €666m to €2bn.

Today's ESRI report, which Health Minister Leo Varadkar commissioned to investigate the cost of the multi-payer system, cannot tell us if we would end up healthier or have quicker access to surgery or specialist appointments under the proposed system.

It comes with no guarantees that we could get an operation when we need it or even get a same-day appointment with a GP.

The ability of hospitals to cope has not been measured.

The fear is that without the current safety valve of having 2.1 million people covered by health insurance - and not reliant on the public hospital system - waiting lists could get even worse.

So what kind of health service can we expect now that the great panacea has been pushed into the far distance? It's back to the two-tier system of waiting lists for people who rely on the public health system.

The latest figures showed the numbers waiting for over 18 months for an outpatient appointment increased to 13,353, rising for the fourth month in a row.

There were another 2,161 facing a similar delay for an operation, a drop of just 83 over the previous month.

The old bottlenecks remain, despite so-called "winter initiatives" implemented over many years by successive government where generous extra funds are found to try to "blitz " waiting lists.

It is yet to be seen if the latest new idea of fining hospitals that fail to meet waiting list targets and rewarding others, will have any real effect.

The reality is that there will be no radical change in reducing waiting lists in the coming years. The best that can be hoped for is that the delays will not be too extreme. But there is no point in raising expectations, particularly when it is proving so difficult to recruit staff.

What we can expect are promises to offer us some elements of universal entitlements, now we are denied the full package. This will essentially be a further extension of free GP care which was introduced for the under-sixes during the summer. The next phase will involve the under-12s at the end of next year and it will be extended to older children in time. The upcoming election manifestos are likely to try to put some sort of timetable on this.

However, this must be done in an orderly fashion because GPs will not be able to cope with the workload. It will also prove costly because GPs are insisting it can only happen if their contract for medical card patients is dramatically improved.

The other reform is likely to involve more payments and incentives to GPs to look after more patients with long-term conditions in the community rather than having them reliant on hospital services.

The first small steps in this area have already been taken for medical card holders with diabetes and children under-six with asthma.

As for the rest of the proposed reforms that are now four years old, the progress has been slow or even static.

We were told the HSE would be abolished. But now that universal health insurance is shelved, it is likely to enjoy an indefinite stay of execution.

Irish Independent

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