Dáil Éireann Debate, Thursday - 14 February 2013
10. Deputy Michael Creed asked the Minister for Health if he will outline the progress made to date regarding the policy objective of universal health insurance; if he will further outline the remaining steps to be taken before this policy objective can be met; and if he will make a statement on the matter. [7484/13]
View answer344. Deputy Nicky McFadden asked the Minister for Health the progress being made towards the eventual introduction of universal health insurance and the elimination of the current two tier system; and if he will make a statement on the matter. [7964/13]
View answerI propose to take Questions Nos. 10 and 344 together.
The Government is embarking on a major reform programme for the health system, the aim of which is to deliver a single tier health service, supported by universal health insurance, UHI, where access is based on need, not on income.
The Department, in consultation with the UHI implementation group, has identified the key building blocks for UHI and arranged them into broad workstreams as follows: primary care reform, hospital structures, hospital financing, regulation of health care providers, health insurance market and overarching UHI design.
Work is progressing under all of these work streams, some examples of which include the drafting of legislation to extend access to GP services without fees to people with prescribed illnesses, the work of the strategic board on the establishment of hospital groups, the significant progress made by the special delivery unit in reducing waiting times for scheduled and unscheduled care, the development of a "money follows the patient" policy, which is due to be published shortly, the development of national health care standards, ongoing work in relation to supporting licensing legislation, and the enactment of the Health Insurance (Amendment) Act 2012 to provide for a new scheme of risk equalisation for the private health insurance market from 1 January 2013. By bringing that clarity to the system, we have allowed a further agent into the market. The reform programme is a major undertaking that requires careful planning and sequencing over a number of years. Full implementation of universal health insurance will take some time to achieve. It is anticipated that the necessary groundwork to enable us to phase in the implementation of universal health insurance, as promised in the programme for Government, will be in place by 2016.
Additional information not given on the floor of the House
The Department is preparing a White Paper on universal health insurance, which will provide further detail on the universal health insurance model for Ireland in addition to the estimated costs and financing mechanisms associated with its introduction. This complex and technical work demands a wide range of specialised legal and financial expertise which the Department is in the process of engaging. The White Paper will be published as early as possible in the Government’s term of office. In advance of the White Paper, my Department has produced a preliminary paper on universal health insurance, which I intend to publish shortly. This will provide a more detailed progress report on work in relation to universal health insurance.
We have been over this ground before. We are waiting for the publication of the White Paper on universal health insurance. The Minister is nearly two years into his tenure as Minister for Health. Before the 2011 election, he spoke about the model he intended to use as a basic building block when funding universal health insurance. That was the Dutch model, as he outlined on numerous occasions. Two years down the road, we are still awaiting the publication of the White Paper. I assume it will be followed by a process of consultation. We are no nearer than we were two years ago, when the Minister was parading the Dutch system around the country, to finding out what exact type of universal health insurance scheme will be used as the foundation of the funding of our health services in the future. There should be a sense of urgency about it at this stage. We are making decisions on primary care, etc., in hospital trusts, groupings and small hospital frameworks, but the fundamental principle of how the health service is to be funded has yet to be made available to us. I ask the Minister to unveil the Dutch model or whatever other model is to be used. We want to know how the health services are to be funded.
We have come back to the White Paper, which would at least be a starting point for a focused discussion on all of this. When will the White Paper on financing universal health insurance be presented? It had been indicated that it would be published in the early part of the Government's first term. When I asked the Minister how long he thought that term would last, he said the plan was to serve for a full five years. That is my recollection of the Minister's answer. The first part of that term has certainly gone by now, but we seem to be none the wiser. Universal health insurance has always been lauded by the Minister and others as a cornerstone of the Government's health policy. Does he accept that when Fine Gael and the Labour Party adopted the universal health care model, the economy was not far from the high point of the Celtic tiger years, when unprecedented numbers of people were taking out private health insurance? We all recognise that the pendulum has swung the other way. Deputy Kelleher mentioned this to the Minister on an earlier Priority Question. As more and more people move away from private health insurance because they cannot afford it, is a fundamental rethink of the Minister's approach not required? Would it not be better for us to debate health funding rather than proceeding with a model that appears to be based on competing private insurance companies? The Minister's former ministerial colleague, Deputy Shortall, has been hugely critical of the competing private insurance model, as distinct from a State insurance scheme, which we would be interested to hear more about if the Minister is willing to discuss it.
It is important to point out that we have to fix the immediate problems in the service for those who have to use it on a day-to-day basis. That is something we are doing. I mentioned earlier that I am focused on outcomes for patients, as opposed to inputs. To that end, I would like to point out again that there were 20,352 fewer patients on trolleys in 2012 than in 2011. That represents a reduction of almost 24%.
We know.
By the end of December 2012, the number of adults-----
The Minister is climbing the trolleys.
Sorry; I did not interrupt the Deputy. Every time I want to read facts into the record, he seeks to interrupt.
I do not. That is unfair.
I am going to stay here until I have read them.
I do not seek to interrupt. We have been here for an hour and a quarter.
By the end of December 2012, the number of-----
I do not seek to interrupt on a regular basis.
-----adults having to wait more than nine months for inpatient and day-case surgery was down to 86 from a total of 3,706 in December 2011. This represents a decrease of 98%.
What about the universal insurance model?
The number of children waiting more than 20 weeks for inpatient or day-case surgery was down to 89 from 1,759 in December 2011.
Did anybody over there hear the questions we asked?
This marks a 95% decrease.
The Minister is filibustering now.
I am not.
He should be speaking about universal health insurance.
The number of patients waiting more than 13 weeks for routine endoscopy decreased by 99% from 4,590.
The Minister of State, Deputy Alex White, can only be embarrassed by this.
Far from it. The reality is that the Deputies continually allude to a single system. I made two things very clear when I was in opposition, and we have made them very clear since we came into government. The first thing, which relates to Deputy Ó Caoláin's question, is that the programme for Government makes it clear that there will be multiple insurers in a competing market. The alternative argument is over.
The Labour Party lost.
Regardless of who may have continued to raise the argument, it is not Government policy.
Labour lost again.
It is in the programme for Government.
The Labour Party is very much a part of this. It is as much a part of it as Fine Gael is. Its members have been absolutely supportive of it.
That is not the case. They have lost their way.
The second issue to raise is that-----
Deputy Ó Caoláin should read the programme for Government, if he can understand it.
That is the element of the Dutch system which we sought to emulate.
I can pass him a copy of it. He should ask Deputy Shortall about it.
We looked to the Danish system when establishing a patient safety authority. Advances have been made there and in Canada. We looked to the UK in the case of the trust model for hospitals. We first saw the special delivery unit system in operation in Northern Ireland. Far from being based on the Dutch system, our approach is based on several systems. I always said we would take the best element of each system that fits the Irish situation. We are continuing to do that. The funding of the model is quite simple. We are going to raise the funds through the existing insurance premiums and through general taxation. That is how the system operates now. There is no particular mystery to that.
Why pay for it, so?
I must bring Question Time to an end. I wish Members a happy Valentine's evening, for what is left of it at this stage.
We had other plans.
