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Priority Questions - Health Insurance

Tuesday, 27 March 2012

Dáil Éireann Debate
Vol. 760 No. 3

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 6.  Deputy Billy Kelleher Information on Billy Kelleher Zoom on Billy Kelleher  asked the Minister for Health Information on Dr James Reilly Zoom on Dr James Reilly  if he will provide an update on the progress of the implementation group for universal health insurance; the model of care on which UHI will be based; and if he will make a statement on the matter. [16566/12]

Deputy James Reilly: Information on Dr James Reilly Zoom on Dr James Reilly I recently established an implementation group on universal health insurance. This group will play a central role in assisting the Government to deliver on its commitment to introduce a single tier health system, supported by universal health insurance. For too long there has been a two tier system operating in our hospitals and which has been very detrimental to those who cannot afford insurance. They are forced to wait a long time for their health care. I refer to the tragic case of the late Susie Long and unfortunately there are many others who have also suffered consequences. I want to see this end, as does this Government. This group will assist in developing detailed and costed implementation proposals for universal health insurance and will actively help drive the implementation of various elements of the reform programme. It will, therefore, have a dynamic role with a strong practical focus on implementation. It will report to me on an ongoing basis. The first meeting of the group was held on 1 March 2012 and it will meet again before Easter.

In designing the model of care on which universal health insurance will be based, I want to ensure that it meets the needs of the Irish system and that it achieves the best outcomes for patients. This requires that we carefully plan and sequence the reform programme and that we give detailed consideration to the most appropriate structures for delivery of different services. We also need to look at the relationships between services and at best practice in health care reform.

Officials in my Department have been examining the experience of health reforms in a range of countries, including in the Netherlands and in Germany. This analysis is vital to enhancing our knowledge and informing policy. I want to implement a model of care which best meets Irish needs but which also builds on best international experience. This is reflected in the membership of the universal health insurance implementation group. The membership comprises a mix of those with executive responsibilities within our health services and external expertise, including international experts working with the World Health Organisation and the European Observatory on Health Systems and Policies. In line with the pragmatic focus of the group, its membership will be flexible and subject to periodic review as different stages of the implementation process are reached. It is my intention that the group will also consult widely as part of the reform implementation process.

Deputy Billy Kelleher: Information on Billy Kelleher Zoom on Billy Kelleher I welcome the Minister’s reply. The provision of universal health insurance is a key Government commitment and the established implementation body is wide-ranging, drawing on a cross-section of expertise. Is it charged with implementing universal [605]health insurance of some form or other or might it state its belief to be that universal health insurance based on the criteria laid down in the programme of Government would not work? The Minister commented on the Dutch model and the group is looking also at the German model and elsewhere. Are there overall instructions to bring forward a universal health insurance policy, or has the group the authority to state it does not believe a universal health insurance system, as proposed by the Minister, as has evolved in Holland, is suitable or practical for the Irish health system as traditionally established and funded?

Deputy James Reilly: Information on Dr James Reilly Zoom on Dr James Reilly I can make my answer very short. This group has been put together to advise how to implement universal health insurance as per the mandate given this Government by the people. Its mandate is to come back in October with a White Paper that will give a steer on how we should proceed onwards from that point. In answer to the Deputy’s question, therefore, it is not open to the group to start looking at all sorts of different systems other than a universal health insurance system.

Deputy Billy Kelleher: Information on Billy Kelleher Zoom on Billy Kelleher There is a reason for my question. The Minister spoke about a mandate; he is very strong in his view that he has a mandate for universal health insurance. Equally, however, he has a mandate not to hike insurance premia, as he stated prior to the election. He was not given a mandate to bring forward proposals and policies that would hike up private health insurance. The conduct of policies in the budget of last year has been the exact opposite.

The Dutch model, for example, is clearly under huge stress and will have enormous difficulties in the years ahead in funding itself. It is now curtailing supports and services to people, in particular those at the latter stages of life. There should be a strong debate on that subject in this House. The Minister claims he has this mandate and I do not deny this. Equally, however, this House should have a role with a strong debate on how we will go about funding health services. The change the Minister proposes may not be suitable or applicable to the Irish system that has evolved over many years. The Minister stated, and all the reports show, that the Irish health services have moved forward and have increased quality of life for patients on a broader basis. What is happening here is not all wrong.

Deputy James Reilly: Information on Dr James Reilly Zoom on Dr James Reilly In the interests of clarity, the Deputy is right. All is not wrong, there is much that is very good about the Irish health service. What is particularly good about it are the excellent people we have working in it. It was the system within which they were working that was preventing them from delivering the sort of care at the speed and access people require. That is why we are changing the system. I put it to the Deputy we made it very clear that we would first maximise what we have. That means fixing the inefficiencies in the system, bringing in a money-follows-the-patient system so that there will be a very clear tracking of patients as well as a focus on the patient. Heretofore we had a system that was self-serving rather than one where patients were the focus. They will now be the focus of the system because, simply put, if there is no patient there will be no payment. Only when that is sorted would we bring in universal health insurance.

We have many parallels working at the same time, moving towards the single end point, the universal health insurance system.

Deputy Billy Kelleher: Information on Billy Kelleher Zoom on Billy Kelleher Parallel lines never meet.

Deputy James Reilly: Information on Dr James Reilly Zoom on Dr James Reilly They are moving towards the same point across another line which is perpendicular and they will arrive at the point we require. If we wish to continue with this kind of mathematics we can put them through a prism that will ensure they will all join at the end point we so desire — the one the people of this country voted for and which they deserve, a system where the medical needs of people are met and is not dependent on what is in their [606]pocket but on how acute is their medical condition and the urgency with which it should be treated. I never want a parent to look into the cot at night, wonder whether the baby has meningitis and wonder whether she should take the baby to the doctor or pay the ESB bill at the end of the week. It is not right, moral or ethical and is not reflective of a society that cherishes all its citizens equally.

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