Tuesday 23 January 2018

Reilly must get it right on major public reform

If this plan goes awry, great cynicism will manifest at the ballot boxes, writes Fionnan Sheahan, Group Political Editor

Health Minister James Reilly needs to get it right with universal health insurance
Health Minister James Reilly needs to get it right with universal health insurance
Fionnan Sheahan

Fionnan Sheahan

'THE white paper underpins the Government's resolve to deliver on the Programme for Government commitment to end the current unaffordable and unfair two-tier system and establish a single-tier health service where access to services is based on need and not on ability to pay."

Dr James Reilly's vision of the health service seems to send a shiver down the spines of many paying for health insurance to guarantee access to the private system.

The clash between the idealism of the creation of a utopian health service and the scepticism of the system operating efficiently threatens to derail the plans to introduce Universal Health Insurance.

In the post-recovery mood of the country, the Government is taking a big gamble on UHI, which is causing great uncertainty for the middle classes and will take years to assess its success or failure.

After seven years of higher taxes and cuts in services, there is little appetite for giving the benefit of the doubt to ambitious initiatives – the outcome of which is difficult to ascertain.

The Coalition is promising a "national conversation" – a dreadfully cliched concept, regardless of the topic – about UHI and the future of the health service.

Before the conversation has even begun, the opponents to the reform intent on protecting the status quo are already lining up to bog it down.

The Coalition's greatest obstacle is not the vested interests blocking the path to the change but the effect their actions are having on those with private health insurance.

Every criticism of UHI, whether based upon fact or perception, adds to the cynicism around the feasibility of the project.

Nobody would object to the promised land of an effective health system with adequate levels of staffing and services delivered promptly – if they thought it would happen.

But false dawns have been seen before and lavish spending during the Celtic Tiger days have not solved the problem.

The UHI template is by no means a waste of time.

A lot of the steps towards UHI make abundant sense, irrespective of whether the ultimate changeover happens.

A National Pricing Office, to determine the actual cost of treatments, makes sense.

A Healthcare Commissioning Agency, to purchase services from public and private hospitals, makes sense.

The move to hospital groups, where hospitals in a geographic region work together to specialise in particular treatments and share the burden, makes sense.

The move to the Money Follows The Patient model, where hospitals are funded based on the numbers of patients treated, rather than just a block grant, makes sense.

A Public Safety Agency and a body to promote health and well-being makes sense.

The Government is not past the point of no return on UHI and all of these changes can happen without taking the final step.

But the Coalition will have to convince those who happily pay to jump the queue at the moment of the merits of the system.

The enormity of the task is not to be dismissed.

Herein lies the difficulty: many of the sceptics are middle income earners who will make their views known at the ballot box.

The Coalition has broken the population into three categories in terms of who will be catered for under UHI.

Those on medical cards will get their entire cost of insurance covered.

Those without medical cards and who currently can't afford health insurance will be subsidised. The argument being put forward by opponents of UHI is these are the people who will be forced to take out insurance.

The contrary point is UHI will make health insurance affordable for those currently with no cover.

Those currently with health insurance will continue to pay and are being assured they will benefit from free GP care, lower premiums and a better service.

The Government is already losing the argument around convincing this coterie of the advantages of the system.

The poll shows almost half believe the Government is responsible for the recent increases in premiums. A fair point following the changes to tax relief in this year's Budget.

But Dr Reilly's national conversation will have to explain that the price of health insurance will continue to spiral if the system continues unchecked.

The broader competition and efficiencies to come under UHI will help to drive down the cost of health insurance.

The argument is hardly helped when the Department of Public Expenditure has put out a figure of €1,600 per person, which has now lodged in the psyche.

The vacuum of detail on the cost of UHI, left by Dr Reilly's white paper, has been filled by alternative calculations and speculation.

The challenge of implementing UHI goes beyond the nuts and bolts of the radical overhaul of the system to simply bringing the public along with the change.

The second part of the equation will determine if the first part will happen.

Sunday Independent

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