The reforms proposed by Minister for Health James Reilly in his draft White Paper on universal health insurance would represent some of the most radical changes ever to the system of healthcare provision in Ireland.
Under the plans, the current two-tier system of private and public healthcare would be abolished.
In its place a new system would be introduced – to be fully in place by 2019 – which would see everyone in the country having to purchase a universal health insurance policy from one of a number of competing companies.
This standard policy would cover a set range of services, to be determined definitively following a comprehensive public consultation process.
However, the document proposes a “preferred” basket of services which could be covered in the standard package. These include universal primary care, including core GP and community nurse services and the maternity and infant care scheme. Acute hospital care – including all inpatient, day case and outpatient care – would be covered, as would chronic disease and care management for those who met specific clinical criteria.
The “preferred”package would also cover acute mental healthcare including those provided by community mental health teams, in outpatient clinics, day hospitals, day centres and acute in-patient facilities for not more than 12 months.
Rehabilitative care would also be included for a period not exceeding a year while step-down care in a residential setting or the patient’s home would be covered for a maximum of two weeks.
Under the draft White Paper, the State would also pay for other elements of healthcare not included in the standard package. These would include immunisations, screening services, ambulance services and hospital emergency department care. The State would also pay for long-term residential care.
Under the new arrangements, the State would pay the cost of the insurance premium for lower income groups and subsidise the cost for others.
The draft White Paper does not forecast the cost of the standard package insurance policy or speculate on the income thresholds for which subsidies would apply.
The document says that “the inclusion of pharmaceuticals (subject to co-payment) either as part of the standard universal health insurance package or through a separate eligibility scheme replacing the current GMS and drug payment scheme will be considered”.
It adds: “In particular the Government wishes to continue to cover the drug costs of the lowest income groups, as currently applies.”
Dr Reilly’s proposals would permit people to take out supplementary health insurance to cover items not included in the standard package. This would include private rooms in hospitals.
However, for the first time this supplementary insurance would be provided on a risk-related basis rather than on a community-rated basis where everyone pays the same for identical products, regardless of age.
The State would put in place a comprehensive cost control framework for the system of universal health insurance. This would include price monitoring of insurers and a mechanism to allow the Minister to set maximum prices for specific services.
