EVERYONE IN the State will be entitled to subsidised GP care if the recommendations of a new report on health service funding commissioned by Minister for Health Mary Harney are implemented.
The report, published yesterday, proposes scrapping existing schemes in favour of primary care cards for all. These would replace schemes for the medical card, GP visit cards, drug refunds and long-term illness, and tax reliefs on healthcare spending
There would be four types of card – ranging from a basic one for those on higher incomes (who would have subsidised GP care and subsidised drug costs depending on the amount of medicines used) to one with comprehensive benefits for those on the lowest incomes and those with chronic diseases (allowing them free GP care and free medicines).
“This graduation would have the effect of reducing the single worst feature in the current system of care, namely the vast differences in the out-of-pocket cost of primary care services to people without a medical card,” it says.
GPs would be paid a capitation fee for seeing patients at reduced prices. Those on the basic card would pay €40 for GP visits and the GP would get an estimated €5 from the State. GPs would get about €15 for seeing patients with means-tested cards which entitled them to see GPs for €30; and €25 for patients with cards entitling them to see GPs for €20.
The hospital care system would remain largely unchanged under the new system but it would be more integrated with the primary care system, with funding allocated on the basis of hospital activity levels rather than “organisations”.
The full cost of private beds in public hospitals would be recovered by the State, and management of waiting lists would be returned from the National Treatment Purchase Fund to the Health Service Executive which would have to offer “guaranteed” and not “target” waiting times.
The Report of the Expert Group on Resource Allocation and Financing in the Health Sectorsaid it believed prescription charges for medical card patients, to be introduced after legislation governing the controversial move passed all stages in the Oireachtas this week, could do more harm than good.
It said it was unlikely the scheme would raise enough revenue “to justify the administration costs” of the change.
It also strongly criticised how health service funding is allocated, saying there was a lack of transparency and a tendency to allocate resources on the basis of historical patterns rather than need leading to “serious inequities in access to care” and resulting in numerous anomalies in terms of incentives for users of the system.
“While equity and fairness are key objectives of Irish healthcare, the financing mechanisms used in Ireland to finance healthcare are highly inequitable, placing particular burdens on people who are just above the medical card and GP visit card threshold and/or who require regular contact with primary and community care services,” it said.
It looked at best practice in other countries and at a social insurance based healthcare system as opposed to a tax-based system but did not come down firmly on either side. What mattered most it said was the effectiveness of the system put in place, not how it was financed.
Opposition parties said the report would not bring an end to the current two-tier system of healthcare.
Ms Harney did not say if she endorsed the report’s 35 recommendations but said she was in favour of a “tiered” approach to primary care as outlined in the report.
She confirmed she would bring proposals for change to Government later in the year.