Dáil Éireann Debate, Thursday - 9 July 2015
1. Deputy Billy Kelleher asked the Minister for Health if he will provide an update on the implementation of the commitments in the programme for Government on universal health insurance; his views that both parties in government remain committed to the goal of universal health insurance, based on multiple insurers; and if he will make a statement on the matter. [27791/15]
View answerWill the Minister for Health provide an update on the implementation of the commitments in the programme for Government on universal health insurance and his views on whether both parties in government remain committed to the goal of universal health insurance based on multiple insurers as opposed to universal health care? I would appreciate it if a bit of honesty could be brought to the debate on this issue. We now have conflicting views and reports from various Ministers, the Taoiseach and the Tánaiste and there seems to be continual change of emphasis in the language from the Minister around universal health care as opposed to universal health insurance.
The Government is committed to a major programme of reform for the health service, the aim of which is to deliver a single-tier health service where access is based on need and not income. The White Paper on universal health insurance was published on 2 April 2014. Following its publication, a major costing exercise involving the Department of Health, the ESRI and others was initiated to examine the cost implications of a change to a multi-payer, universal health insurance, UHI, model, as proposed in the White Paper. Draft results from the initial phase of the costing exercise were presented to me at the end of May. These draft results are now informing deliberations on next steps, including the necessity for further research and cost modelling.
Ultimately, the UHI costing exercise is a major research project with a number of phases. The next phases in the costing exercise are likely to include deeper analysis of the key issue of unmet need and a more detailed comparative analysis of the relative costs and benefits of alternative funding models.
This will inform Government discussions on the best long-term approach to achieving universal health care. It is important that universal access does not result in shared but longer waiting lists for all, but instead results in more health care needs being met in a timely manner. For this reason additional analysis of unmet need and capacity is important as we implement changes on a phased basis.
Finally, I have already indicated that it will not be possible to introduce a full universal health insurance system by 2019, as envisaged in the White Paper. However, I emphasise my commitment to universal health care and to implementing key health reforms, as set out in the programme for Government and the White Paper. In particular, I have pushed ahead with critical building blocks for universal health care, including the phased extension of universal general practitioner care without fees, improved management of chronic disease in the community, implementation of financial reforms, including activity-based funding, and the establishment of the hospital groups. We have recently seen significant progress in the extension of GP care without fees to children under six years of age and we are also seeing the phased expansion of free GP care to all those aged 70 years and above from August. The introduction of universal GP access for the youngest and oldest in our society is an important step on the path to universal health care.
That is an extraordinary reply. We are back to the same old view that has been expressed by the Minister in recent times in respect of universal health care. I remind the Minister that the programme for Government states:
This Government will introduce Universal Health Insurance with equal access to care for all...A system of Universal Health Insurance (UHI) will be introduced by 2016, with the legislative and organisational groundwork for the system complete with this Government's term of office.
The idea that the Government is now saying that no due diligence was done on how it would implement universal health insurance in advance of the last election and in advance of putting it into the programme for Government is extraordinary. It is the case that the Government is making this up as it goes along. It is evident that the Minister is fundamentally opposed to universal health insurance. The Taoiseach is attaching himself to it with pretence. He comes into the House and effectively says he is committed to it, although the Minister has abandoned the idea of bringing in universal health insurance.
Many Members subscribe to the idea of universal health care, but the question of how we fund our health services is the critical issue. We are not talking about opposing some concept of universal health care, but universal health insurance is the Government's stated way of funding universal health care and the Government seems to have abandoned it. We need honesty and straight, upfront views on what the Government is going to do with regard to universal health insurance.
I appeal to Deputies to stick to the time limit. What happens is that when we get to Other Questions for ordinary backbenchers, there is not enough time to answer them because we are taking up too much time on Priority Questions.
There is none here.
There is no such thing as ordinary backbenchers.
They will not come to the Chamber until we get to Other Questions.
I know there is a good deal of debate and comment around terminology. Universal health care is a group term meaning access to health care on an equal basis, based on need rather than ability to pay. There are many ways of bringing that about. Universal health insurance is one of those. We can have a multi-payer or a single payer system, a social insurance-based system, a tax-based system or an out-of-pocket system. These are all different ways of funding it.
Another element in the programme for Government is the extension of GP care without fees. That is not being done through insurance and it was never envisaged that it would be done through insurance. We spent a considerable period in negotiations with the Irish Medical Organisation on that contract on the basis that it would be based on a tax-funded system. There is a separate part in the programme for Government on that aspect.
Obviously, a considerable amount of work has had to be done in the meantime. The costings indicate that universal health insurance would be very expensive and that the premiums would be very high. Maybe they need to be high, because any universal health care system worth having is one that delivers timely health care. We could have universal health care tomorrow and simply put everyone on a waiting list, but I am unsure whether that would be very attractive.
Unfortunately, it is a case of what a tangled web we weave when first we start to deceive. There is no doubt those in government are forgetting what they have said with regard to the health policy and how it is to be funded. When announcing the White Paper on 2 April 2014, the Taoiseach stated that "Those with existing health insurance will now for the first time have primary care services included." It would have been fine if he announced that on 1 April because it is a fool's document and the Government is trying to make a fool of everyone in this House and those on the street as well.
The Minister has a fundamental opposition to universal health insurance. The Taoiseach comes to the House on a regular basis and pretends that it is a central plank of Government policy while his Minister is undermining it.
A question, please.
Will the Minister once and for all tell us clearly whether he is committed to universal health insurance as opposed to universal health care? We all subscribe to the principle of universal health care. The key issue is how we fund it. Is the Minister committed to universal health insurance, as proscribed in the programme for Government?
When it comes to whether it covers GP care, it depends entirely on what policy people have. Many people have a policy already that covers GP care, but most people do not and chose not to take that out. Where we differ is that I do not believe the most fundamental question is how the money is collected and funded.
Is the Minister referring to where we differ or where he and the Taoiseach differ?
The fundamental question is whether the health services are adequately funded. No matter what the system, if the funding and staffing levels are inadequate, then it will not be a good health service. The second thing is to ensure that money is spent well. This comes from activity-based funding. We are very much pushing ahead with activity-based funding to ensure that money follows the patient and that hospitals are paid for what they do. Research has been done by the ESRI and I look forward to publishing it as soon as possible. The research indicates different sets of costings. We could apply universal health insurance only to hospitals, to hospitals plus primary care or to hospitals plus primary care plus drugs and social care.
The commitment is to primary care.
All those things need to be determined. We also have to get other things right first; things which have not been got right.
