‘Government health service plans require an extra 1,000 GPs’

IRELAND will need at least an extra 1,000 GPs to facilitate Government plans to overhaul the health service, a major conference on health reform heard yesterday.

Proposals by Health Minister James Reilly to introduce a Dutch style health service here may not work, delegates were told at the forum, “A New Government — New Health System?” at University College Cork.

“We already have a problem retaining a sufficient number of doctors in our system,” IMO president Dr Ronan Boland told delegates at the conference hosted by the Health Economics Group in the Department of Economics at UCC.

“The only reason we get away with fewer doctors than other developed nations is because two thirds of the population do not access GP services appropriately, due to the cost involved,” he said. “If we introduce a free service, we will need another 1,000 doctors, but we do not have them.”

However, he said that a partial solution would be allowing a greater role for pharmacists and nurses in primary care, with GPs acting as medical supervisors in some sets of circumstances.

Dr Boland said that in the light of calls for a reduction in medical fees, hospital consultants have already taken salary reductions of 35% which he described as “the biggest pay cuts in the country in the past two years”.

He added: “GPs have suffered similar reductions and, already countries like New Zealand are offering graduates and young doctors more attractive pay packages.”

The Government’s plan envisages the most radical shake-up of the health system for generations, with the elimination of the existing two-tier health system, the introduction of free GP care for all and universal health insurance.

Dr Boland said he had not been given any proper understanding of the proposals and was ‘none the wiser’ after meeting Minister Reilly. He called for a clear roadmap for reform.

Addressing the conference earlier, Dr Brian Turner of UCC’s Economics Department said the Government’s proposals will have major implications right across the health system.

“GPs and consultants will face new reimbursement arrangements; hospitals will have to compete for patients, while insurers will have a much greater role in purchasing care on behalf of the entire population,” said Dr Turner.

John Armstrong of the Institute of Public Administration, told delegates that universal health care should focus on affordability, quality and efficiency. He warned against the crudeness of importing a health care system from one jurisdiction to another.

“We have to be careful,” he said. “Each country is different and the Dutch model would not work in the Irish context.”

Mr Armstrong, head of health pricing with Aviva and lecturer in health insurance at the Erasmus University in Rotterdam, said that Ireland’s current risk equalisation system was not robust enough.

Delegates also heard a note of caution from Professor Wynand Van de Ven who helped spearhead reform of the Dutch health care system in the 1990s.

Outlining the evolution of the health service in the Netherlands in the past 30 years, Prof Van de Van said that, although the current system is a huge improvement on what went before, there are still problems and it was too early to fully assess its effectiveness. “The jury is still out,” he told delegates.

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