Family doctors are collectively receiving between €200 million and €220 million a year from their private patients, a new Department of Public Expenditure spending review has estimated.
However, it warns the cost of implementing a universal free GP care programme would not be as simple as the State taking over these private costs and allowing for an increase in the number of times people would visit their doctor under such a scheme.
It says the Department of Public Expenditure in 2019 had estimated “that extending free GP care to the entire population on the same terms as the currently covered cohort would cost upward of €630m per annum”.
The review says based on its estimates of private GP earnings , the opportunity cost of providing free GP care to all would be, arithmetically, in the region of between €240million and €308million.
However it warns that this would be “undoubtedly a simplification of a more complex reality”.
It says increased demand could not be purchased without consideration of the capacity in the overall GP system. It also warns that changing the current structure to introduce free GP services for all “would likely have complex cost and structural effects in terms of what is delivered and how it is delivered”.
Alternative model
It argues that moving from the existing semi-private to a fully-public system would necessarily require an alternative model of employment between GPs and the State, the terms of which would have to be subject to negotiation.
“ Finally it does not automatically follow that the full costs of GP care provision will be covered solely via the Exchequer on current tax arrangements; many countries fund or partially fund healthcare via a higher rate of healthcare related taxation (PRSI in Ireland), and/or through co-payment models.”
The spending review, which was published on Thursday, says that "the implementation of universal GP care in Ireland has formed part of the policy agenda of several Irish Governments in recent years".
It says a variety of policy rationales exist for the provision of free-at-point-of-access primary care; these range from public health, health system planning and efficiency, and social equity considerations.
“Reducing and removing barriers to accessing healthcare, perhaps unsurprisingly, is linked to positive public health outcomes.”
“While the purpose of the GMS (or medical card) scheme is to provide care to people for whom attaining care privately would be unduly burdensome, the State does not presently have an obligation to ensure access to all people.”
It says that at present GP care in Ireland is provided though a mix of both public and private systems.
It says virtually all GPs are independent private contractors who provide services at market rates, the majority also participate in the GMS scheme under which the State covers the cost of access for “persons for whom acquiring such services would present undue hardship”. It says GMS eligibility “is based on economic means, considering family size, income, and expenditure on mortgage/rent and childcare.”
Categories
The review says that GPs received €564 million collectively last year across a number of categories for treating public patients.
The spending review says there are several estimates for the amount of money paid to GPs annually by private patients and in relation to the increase frequency at which patients would visit their GP if the system was fully without cost.
It suggests €52.50 to be a reasonable estimation of average private GP consultation price in Ireland,
The review maintains that a range of between €200million and €220million represents “a broadly accurate estimate of private GP expenditure”.
The Department of Public Expenditure paper suggests it would be “reasonable to assume a move to universal GP care will result in an increase of roughly 20 per cent - 40 per cent among patients who are currently private”.
