HSE and private health insurance scrapped with plan for single-tier model

THE Government plans to scrap private health insurance and the Health Service Executive (HSE) under a new healthcare model where those who can pay will, and those who can’t will be paid for by the Exchequer.

The proposals commit to developing a single-tier health service where access to care is based on need under a Universal Health Insurance (UHI) model expected to be in place by 2016. This is a system whereby those who can afford to pay will, while the State will pay insurance premia for people on low incomes and subsidise premia for people on middle incomes.

Insurance with a public or private insurer will be compulsory; insurers will be obliged to offer the same package of services to all and will not be allowed to sell insurance giving faster access to procedures covered by a defined UHI package, the make-up of which will be determined by the new health minister.

Other major proposals include:

* Handing back responsibility for health spending and implementing health reform, currently the responsibility of the HSE, to the health minister. This ties in with the proposal to wind up the HSE. Ultimately, HSE functions may be taken over by the new UHI system.

* The HSE’s function of purchasing care for uninsured patients will be given to a Hospital Care Purchase Agency which will combine with the National Treatment Purchase Fund to purchase care for the uninsured over an initial transition period. An Integrated Care Agency will also be set up to integrate community and hospital care.

* Under UHI, public hospitals will no longer be managed by the HSE. They will be independent, not-for-profit trusts with managers accountable to their boards, which will include representatives of local communities and staff. Insurers will not take over the running of hospitals but will negotiate directly with hospitals to control costs.

* A Patient Safety Authority, incorporating HIQA, will introduce a national licensing system for hospitals and oversee the transition of hospitals from the HSE to independent local control.

* The existing policy of co-location of private hospitals on public hospital lands will cease, as will tax incentives for private hospital developments.

* Under a new contract, hospital consultants’ remuneration will be cut.

* Universal Primary Care will be introduced on a statutory and phased basis within the term of office. Ultimately, it will mean everyone has access to free primary care, defined as first-point-of-contact healthcare in the community (including GP visits). GPs will be paid primarily by capitation for the care of their patients, but under the new GP contract their rate of remuneration will be reduced.

A White Paper on Financing UHI will be published early in the Government’s first term and will review cost-effective pricing and funding mechanisms for care and the care to be covered under UHI.