A complete end to private healthcare in State-funded hospitals has been called for by the Dáil committee planning the future of the health service.
Hospital consultants who currently work privately in public hospitals should be paid more in compensation, and rewarded better for elective work in the public sector, its draft report recommends.
The report, seen by The Irish Times, proposes a fund to replace the €621 million income public hospitals would lose as a result of the change.
The charge for public access to public hospital care (up to €800 a year) would be eliminated, the prescription charge for medical card holders reduced from €2.50 to 50 cent and the threshold for drug reimbursement from €144 to €100 a month.
The €100 charge for emergency departments “may” be removed when primary care services have been built up.
It says one hospital in each hospital group would become elective-only to ensure emergency work does not “crowd out” less urgent treatment.
Public and private care in the health system need to be “disentangled” to allow the private sector operate in a free market without Government subsidy and public resources to be channelled to public patients, the report says.
The proposal, if retained in the final report, is likely to set the committee on a collision course with the Government. Ministers Simon Harris and Leo Varadkar both rejected the suggestion tax relief on private health insurance needs to be abolished to help fund a one-tier system.
The existence of private care in the public system - 80 per cent of consultants can treat private patients in public hospitals - undermines social solidarity for patients, the report says.
No-one should have to wait more than 12 weeks for an impatient procedures, 10 weeks for an outpatient appointment and 10 days for a diagnostic test, it says. Individual waiting lists would be published by hospital and specialty.
The report proposes extending free GP care to an additional 500,000 people a year on the basis of low income. Dental benefits would be restored to pre-crisis levels and an universal package of dental care introduced.
While proposing measure to undo two-tier access to public hospitals, including more diagnostics and expanded capacity, the report says the removal of private care in the public system will require time to phase out.
The health and wellbeing budget would be doubled and 900 more general nurses hired to work in the community with older people. The report envisages an additional 600 consultants being appointed from year four of the plan.
The committee proposes the introduction of a health card (Carta Slainte) by 2022, with which all citizens would be entitled to care based on need. Implementation of its plans would be overseen by a group based in the Taoiseach’s office.
The report estimates that creating a single-tier public health system will cost an estimated €5.4 billion over six years.
Up to €1.5 billion could be cut from this bill by diverting savings accruing from reduced out of pocket payments and a reduced need for private insurance to a new national health fund.
The extra funding needed to realise a vastly improved health service comprises up to €400 million a year in additional health funding and €3 billion to fund the transition to a single-tier system and sort out legacy arrangements.
The report proposes the phasing out of the tax subsidy for private health insurance, with the savings being used to expand patient entitlements and cover the cost of the transition to a new system. This could add up to €600 a year to the cost of insurance for a family.
Disentangling of the private and public sectors may mean households having to pay additional charges through taxation or existing levies, depending on how fast the health service moves to a single-tier system.
It says transitional funding of €500 million a year for the next six years will be needed. Finding this money will be a matter for the government of the day.
The committee is due to deliver a final report within weeks, after which the Government will decide whether to implement its proposals.
