Proposals for extending private health insurance to the entire population, which have been supported by Labour and Fine Gael, were criticised in the Department of Health presentation to last week's Cabinet meeting.
The presentation described the work of a strategy group which is examining the case for reforming how the healthcare system is funded. Officials described the pros and cons of alternative systems, including the extension of private health insurance to the entire population, as proposed initially by the Labour Party and later by Fine Gael.
"Discussion so far, points to retaining a centrally funded tax based system, but with increased investment to support it", the Cabinet was told.
The Deloitte and Touche value-for-money study, commissioned by the Department, "points to administrative and logistical problems of shifting to an insurance-based system with little obvious benefit to, for example, health outcomes."
While such a system might make services and new technology more accessible to patients, and would provide more incentives for providers, it could lead to excess capacity in hospital beds and personnel, high labour costs and lack of service integration and planning. It would mean "a significant degree of future planning of health services is given to private insurers".
Control of inflationary costs would be more difficult in a private health insurance environment, as in the United States. A private health insurance system might, however, have "more focus on customer satisfaction".
Another alternative funding system - a social insurance fund covering the entire population - would also lead to excess capacity, high labour costs and lack of service integration and planning.
In reviewing the favoured central taxation funded system, the strategy group believed that its strengths were "good service planning, integration of services helped by present arrangements and strict budgetary control". Its weaknesses were "lack of incentives for providers"; it was "slower in patient responsiveness"; and "full multi-annual budgeting" was "not in place".
The Department's presentation showed an awareness that increases in health spending must also be accompanied by reform of the health system. The current organisational structure involving health boards, the Department, Comhairle na nOspideal and the Medical Council needed "fundamental review" and "radical thinking", the Department's personnel director, Mr Frank Ahern said.
He said that questions which emerged included `have we the correct number of health boards?' and `are there issues re capacity to manage?'
In a review of the health strategy, which the Department is currently preparing, the director of the health strategy project team, Ms Frances Spillane, explained that working groups were examining issues like how the service should be funded, the impact of the public/private mix on healthcare, the "persistent link between poverty and health" and "how to achieve fair access based on need".
They had been asked "to make recommendations for change to achieve a more people-centred, equitable and higher quality health service and improved health status".