Labour's Plan for Fair Health Care
Issued : Tuesday 8 February, 2011
Universal Health Insurance: Irish-style
When Labour's reform is complete, the following will be the key elements of the system:
- Universal primary care insurance instead of the medical card system and payment out of pocket.
- Universal hospital care insurance instead of the two-tier system of private and public patients.
- Public and private hospital care insurers who purchase hospital care for you from competing public and private hospitals and clinics.
- A new public insurer created by combining the National Treatment Purchasing Fund and the purchasing arm of the HSE, both of which currently fund public patient care.
- The right to change insurer.
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Summary
Under Labour's Universal Health Insurance reform no one will be denied access to health care because of their income. Labour will reform the health system to achieve a genuine shift towards primary care by 2014, addressing one of the fundamental weaknesses of the Irish health care system. Labour will end the two-tier system in hospital care, extending access to all on the same basis as the privately insured, and making the hospital system more efficient, with full Universal Hospital Care Insurance operational by 2016.
Labour's UHI policy is costed, planned and timetabled. Labour has based its costings on published Irish research. Universal Primary Care Insurance for every citizen, which covers upfront GP fees, will cost an additional €389 million and will be funded by savings in the health care budget. These savings will be achieved by reducing the prices at which the state pays for drugs; reducing hospital consultants' remuneration; and reducing numbers in health administration. The phased shift towards insured GP care will allow time to increase GPs and practice nurses working in primary care teams. Exchequer funding for primary care will go into a Primary Care Insurance Fund, which will be the insurer of primary care.
In the Universal Hospital Care Insurance system by 2016 everyone will have a choice of insurer - public or private. Insurers will purchase care from hospitals, which will compete to supply care. HSE-owned hospitals will become independent, not-for-profit foundations or trusts. This system will evolve beginning in 2011. The National Treatment Purchase Fund and the purchasing arm of the HSE will combine to become a Hospital Care Purchase Agency that purchases care for the uninsured during the preparation for the full system. In 2016, this agency will become a new public insurer. As in Germany, there will be multiple insurers of hospital care but centralised control of costs and fees.
Irish health care will continue to be funded by a combination of Exchequer resources and insurance. People on lower incomes will have their insurance premia paid by the state; people on middle incomes will have their insurance payments subsidised; and people on higher incomes will continue to pay their premia. Individuals will not be asked to pay more for care than they do today. A guaranteed basket of care, which every insurer will be required to offer, will cover consultant-provided hospital care and semi-private accommodation in hospitals - public or private. Yet, unlike the current unfair system, under Universal Health Insurance, anyone who can no longer afford a premium due to loss of a job or a fall in income will no longer lose their hospital care cover.
The cost of UHI in hospital care will be met by increased efficiency in the delivery of care. Under Labour's reform, better primary care, additional investment in community and long-term care and changing how hospitals supply care will enable hospitals achieve up to 18% greater efficiency. Cost reductions and greater efficiency make it a feasible ambition to deliver UHI without adding to the existing Exchequer and insurance funding of hospital care.
