Where will capacity for UHI be found?

The main problems surrounding the introduction of UHI which have not been effectively addressed by the Minister for Health centre on the capacity and cost of the new system, writes Maureen Browne.

Maureen Browne
Maureen Browne

The main problem which has not been effectively addressed by the Minister for Health following publication of the White Paper on Universal Health Insurance is where the capacity will be found to provide timely treatment for all those who need it.

UHI will put an end to the present two tier system where health insurance can provide speedier access to diagnostic and treatment services, but there appears to be no clear plan as to where the additional services will be found to provide timely treatment to the entire population.

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The same number of people can still be expected to be seeking services and it is certainly not clear where they are going to access them or how UHI will end or reduce current elective waiting lists.

The same number of people can still be expected to be seeking services and it is certainly not clear where they are going to access them.

At a very lengthy and high powered press conference to announce the publication of the White Paper on UHI, (it was attended by The Taoiseach, the Tanaiste, the Minister for Health, the Minister for State, the Secretary General and the Deputy Secretary General of the Department of Health and the Director General of the HSE) the Minister indicated that capacity would be found from new models of treatment. These new models of treatment seemed to be based on more and more people being treated at primary care level or the least acute level. While there is certainly room for movement here – provided a deal can be concluded with the country’s GPs – it is difficult to see this how this could possibly deal with the thousands and thousands of people at present awaiting outpatient, day care and inpatient treatment.

There is undoubtedly a major capacity deficit in personnel and resources in our hospital system. While the Minister accepted that we would need additional consultants, he said he didn’t think we would need as many as some people believed (which of course could mean anything as people have a wide range of beliefs in this regard depending on their perspective). No mention was made by the Minister of additional resources for hospitals.

Without additional staff and matching resources I cannot see how the hospitals can possibly provide timely services for all those who seeking it under UHI. No matter how much we wish it 100 into 70 or 80 or even 90 just will not provide results. As things stand at present it seems likely that what will happen is that the current public patients will see their appalling access to service somewhat improved while those who are at present insured will see their access significantly disimproved.

You would expect that those now paying health insurance could expect a dramatic rise in their annual premia.

There are also many questions around the cost of the new system. The Minister said it could not cost more than the present system and should not require higher taxes.

However, it did appear that it would cost many punters considerably more than at present.

Dr. Reilly said that the average premium paid for health insurance in 2013 was €920 following tax relief.   He said that if UHI had been in operation in 2013 “with all of the proposed efficiencies in place” it was likely that the average premium charged would have been lower and insured people would in addition receive free GP care.

It would be interesting to see the basis for these financial calculations. When you take into account that the premia of those at present uninsured will have to be paid or subsidised, tax relief will be ended, the tax levy is expected to be subsumed into general taxation and free GP care will have to be provided you would expect that those now paying health insurance could expect a dramatic rise in their annual premia.

The Minister has said there would be cost savings from efficiencies from the abolition of the two tier system, the new ealthcare Pricing Office – which over time he expects to help deliver prices for medical treatments that are closer to some of the more efficient health systems in Europe – Ministerial control of supplier induced demand, if necessary, and the payment of a specific price for every service to the hospitals instead of the present block grants.

Then of course while the Minister has laid out quite specific timelines for the phased introduction of UHI via the introduction of Money Follows the |Patient, abolition of the HSE, the establishment a Healthcare Commissioning Agency the actual introduction will not be until 2019. We do not know who will then hold the health portfolio or indeed what party or combination of parties will be in power and what their views will be on UHI.