ANALYSIS: There are such profound differences in the health policies put forward in the manifestos of the main political parties that a change of government could lead to major changes, reports Maev-Ann Wren
The health policies put forward by the main parties offer voters a real choice. A change of government could bring radical changes in the health system.
The Opposition parties propose to end the two-tier divide in Irish hospital care between public and private patients. This ambition unites Fine Gael, Labour, the Greens and Sinn Féin. While Fine Gael and Labour would achieve this by universal health insurance, the Greens and Sinn Féin favour a tax-funded public system.
The Opposition also differs from the Government parties in their emphasis on free GP care. While Fine Gael would extend free GP care to the majority of the population, Labour has adopted free GP care for all as a central pledge, which is non-negotiable in talks on a programme for government. The Greens and Sinn Féin also support free GP care for all.
In contrast, Fianna Fáil and the Progressive Democrats are running on the merits of the 10-year national health strategy. Increasing capacity is a greater priority than equitable access. Their policies are compatible with their record: the proportion of the population on medical cards has declined.
Fianna Fáil's party political broadcast features the Minister for Health, Micheál Martin, promising "universal high-quality healthcare for all".
The health strategy is not, however, a blueprint for what would be regarded internationally as a universal healthcare system. While its implementation would undoubtedly improve public patient care, the distinction between public and private patients in public hospitals would remain. Without common waiting lists, there would be no guarantee of treatment on the basis of need rather than ability to pay.
The Government parties have promised to eliminate waiting lists within two years. Fianna Fáil says it will prioritise health spending to achieve this even in an economic downturn. If it does not achieve this promise, public patients will continue to wait longer than private patients. The strategy did not commit the government to ensuring that public patients receive the same quality of care as private patients. It stated that "greater equity for public patients will be sought in a revised contract for hospital consultants". The Department of Finance has opposed efforts by the Department of Health to achieve consultant-delivered care for all.
The PDs advocate continued distinctions between patients. Their manifesto states that "the solution [to the different treatment of public and private patients] is not to try to make one size fit all" but to focus on service levels.
The Government parties have limited ambitions for extending access to free GP care.
Fianna Fáil would offer 200,000 more medical cards at an unspecified time, which would increase the proportion of the population with medical cards from 31 to 35 per cent. The PDs state that they will ensure medical card eligibility at least keeps pace with incomes growth, implying that the proportion of the population covered may remain unchanged.
The radical reform proposed by the major Opposition parties is a universal health insurance system, akin to the systems in France, Germany and Canada. In Labour's system, everyone would be covered by an insurance company for hospital and primary care, with the State paying or subsidising premiums on a sliding scale for those on lower incomes. The PDs claim that Labour would retain distinctions between patients, since some may top up for extra benefits. However, Labour envisages that top-up insurance would only be permitted for "hotel" benefits like private rooms and could not be used to gain faster access or better treatment.
Fine Gael's health insurance scheme would cover patients only for hospital care and the State would pay all premiums.
Fianna Fáil says universal health insurance is expensive and bureaucratic. Labour points out that half the population is already covered by private health insurance which Fianna Fáil supports. It seems that expense and bureaucracy emerge as issues only when the system is extended to the poorer 50 per cent.
The role of insurance companies is critical to how universal insurance would operate. Labour would mutualise the VHI so that it would not be driven by profit and would insist on community rating and risk equalisation between insurance companies, which this Government has failed to introduce. The Government contemplated but took no decision on privatisation of the VHI. A privatised VHI would be vulnerable to overseas takeover and could, within our existing mixed system, lead to an increased for-profit motive in Irish healthcare, already encouraged by new tax reliefs for for-profit hospitals.
This is the choice: the Government parties would build capacity; the Rainbow parties would simultaneously build capacity and introduce the equitable access which is the European norm. A coalition between Fianna Fáil and Labour would require FF to "give" on the issue of free GP care - Labour's non-negotiable pledge - and would have to reconcile the parties' differences on the future of the two-tier divide.