Sir, – Dr Domhnall McGlacken-Byrne (Letters, May 27th) recommends a tax-funded system for universal healthcare similar to the NHS in the UK, Scandinavia and Canada, as opposed to an insurance system of funding as put forward by James Reilly TD in 2009.
Tax-funded systems have been shown by the OECD to be associated with long waiting lists, our tax-funded public hospital system being a good example, along with the UK, Sweden and Canada, where waiting lists have been an issue too. Insurance-funded systems as in mainland Europe do not in general have waiting list problems.
Dr McGlacken-Byrne states that James Reilly, former minister for health, had recommended the German model of health insurance.
This is not correct. I produced a document on funding healthcare to James Reilly in 2007 that recommended the Dutch model of single public insurance for all, introduced there in 2006, and not the German mixed public and private health insurance system. The recommendation was subsequently accepted as the basis for funding James Reilly’s Fair Care health policy in 2009.
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The Dutch single insurance system for hospital and primary care is regarded by the OECD as a public funding system given its strong regulation by the government.
In making my recommendations to Dr Reilly at the time, I had been influenced by an OECD report in 2004 by the health equity research group in the OECD that had shown Ireland as having the third most inequitable hospital system of 21 countries studied: that is, it was pro-rich when it came to accessing hospital care.
Nothing has changed since and if anything has deteriorated.
The study found that the main contributory factor for this inequity was the presence of fee for service private health insurance funding of private patient care.
On the other hand, the 2004 report revealed that the Netherlands had the most equitable hospital and primary care system of the 21 countries studied.
Dr McGlacken-Byrne commends us to support Sláintecare, something I have difficulty doing, as private health insurance funding remains embedded in Sláintecare and will guarantee the persistence of inequity of access to hospital care. – Yours, etc,
Dr JOHN BARTON,
(Member of Government Implementation Group
on Universal Health Insurance 2011 to 2014),
Galway.