ESRI: New methods required for universal healthcare

If Ireland is to deliver universal healthcare it may have to consider different methods to achieve it, such as introducing compulsory private insurance for elective hospital care, according to a new report.

The study by the Economic and Social Research Institute (ESRI), entitled ‘Challenges in Achieving Universal Healthcare in Ireland’, argues there should be a mechanism to tackle Ireland’s two-tier acute hospital care system based on either a public or private purchaser pathway.

Referring to “other inequities and financial barriers to access in Irish healthcare”, the report states that Ireland has a “complex system” at a time when “the international consensus view of the desirability of universality in healthcare is further based on evidence about outcomes for individuals, society, and the economy, with denial of access to care resulting in poorer health outcomes and a diminution in the potential of human capital”.

The report outlines how, in Europe, UHI models are funded either by a tax-financed system or a social insurance-financed system, but states: “No two countries’ healthcare systems are identical and a successful Irish reform is likely to have its own distinct features built on the existing system.”

Regarding potential routes towards universality, it said extending free GP care to under-6s “will facilitate the rollout of new public health measures, such as wellness checks, at relatively low cost to the exchequer and very low cost to Irish society, when the removal of private fees for this grouping is taken into account.

“The potential to build universal primary care from the existing tax-financed system at relatively low cost is a pragmatic argument for continuing on this tax-financed pathway, whether by progressively extending cover on age or income criteria.”

The report states that the case for an alternative pathway would need to be supported by evidence of lower costs or greater cost-effectiveness.

Regarding a universal hospital care system, in addition to a purely tax-financed NHS-style system, another approach would be to develop the model of the National Treatment Purchase Fund purchase of private care for people on public waiting lists, or by introducing compulsory private insurance for elective hospital care.

“Such a system should be designed to ensure payment according to ability to pay and Government control of insurers’ margins and other costs,” according to the report, which is to be officially launched today.


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