Sunday 18 February 2018

Health plan 'won't hike cost to State', insists Reilly

Minister says reform of health insurance will depend on cutting cost to the taxpayer

Health Minister James Reilly at the opening of the Emergency Unit at Letterkenny General Hospital. Picture: NWNewspix
Health Minister James Reilly at the opening of the Emergency Unit at Letterkenny General Hospital. Picture: NWNewspix

Fionnan Sheahan, John Downing and Niall O'Connor

HEALTH Minister James Reilly has inserted a guarantee in his radical health insurance plan that the cost will "not exceed" the spending on the existing two-tier system, the Irish Independent has learned.

Dr Reilly will also have to show hospitals can be run and health services can be delivered at a lower cost to the taxpayer for his reform of the system to go ahead in five years' time.

The preparations for Universal Health Insurance (UHI) will proceed with a view to getting the health service to operate more efficiently.

Depending on how these "stepping stones" work out, coalition sources say the move to UHI in 2019 will be "a decision for the next government".

At the heart of UHI is the end of the two-tier health service, where public patients wait longer than private insurance holders for treatment.

The minister's consultation document on UHI, known as a White Paper, will be discussed by ministers this morning and is due to be published in the coming weeks.

Finance Minister Michael Noonan and Public Spending Minister Brendan Howlin and their officials have expressed serious concerns about the cost of UHI for the State.

In response to the criticism that proposals lack detail on the cost of UHI, Dr Reilly has inserted a cap on spending linked to national expenditure.

"The Government is determined that total spending by the State on health care in Ireland under a single-tier UHI system should not exceed the total spending under the two-tier system, which it replaces.

"This approach will allow for cost-effective, additional investment in health services, in line with increases that are consistent with our Constitutional and legal obligations under the (Fiscal Compact) and the Stability and Growth Pact," the document says.


The new guarantee is intended to assuage the fears of Mr Noonan, in particular.

"He believes in the principle of UHI, but he would be terrified anything you do in health will allow for costs to get out of control," a senior government source said.

Dr Reilly is now going to proceed with a range of measures which are intended to drive down costs in the delivery of health services, rather than just cutting budgets and staffing.

Ministers are especially keen to see the setting up as soon as possible of the National Pricing Office, which will decide the price hospitals will be paid to carry out procedures.

The rollout of 'Money Follows The Patient' – where hospitals get funds based on the numbers of patients treated, rather than a block grant – is also viewed as a priority.

But these measures are regarded as moves that should be undertaken anyway, whether or not UHI comes into effect.

The core principle of UHI is healthcare being equally available to each member of society and treatment based solely on medical need, not income.

Everyone will have cover from a private health insurance company.

Those who can't afford the premium will have it paid for fully, or heavily subsidised, by the State.

Dr Reilly has estimated that 40pc of the population, who currently hold medical cards, will get their health insurance paid in full, with another 30pc getting a heavy subsidy.

Yesterday, both ministers responsible for finance sought to downplay concerns about the health plan and said it could continue as a work in progress.

Mr Noonan said he would not be doing his job if he had not questioned the costings.

"I agree fully with the idea of a one-tier health system which is funded through the insurance industry," he said.

Mr Howlin said he was very confident the Department of Health had the capacity to roll out Universal Health Insurance.

The reform will have huge implications for the two million people who currently hold private health insurance 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.

Irish Independent

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