Health promises - Universal cover must be achieved

Last week, the HSE admitted that more than 5,600 patients in Limerick have been waiting four years or more for an outpatient appointment.

Across the country, 105,632 people have been waiting for more than a year for a first consultant outpatient appointment.

In a country with such inefficiencies in its public health system it is not hard to understand why private health insurance is — or was — so very popular.

It is a divisive issue, open to accusations of queue-jumping and preferential treatment, but the two-tier system’s validity stands as long as our health managers are forced to acknowledge waiting lists stretching over four years. Indeed, many of those who are still members of a scheme regard premiums as a super-tax paid to ensure that they can access health services when they need them. That the country’s largest health insurer is State-owned strengthens that assumption. However, this is not how things should be.

Around 64,000 people left health insurance schemes last year, increasing pressure on a stretched public service. This customer flight — membership fell from 51% to 46% of the population in just four years — in the face of seemingly out-of-control premium increases has hit insurers’ revenues and capabilities hard. Unfortunately, there is no sign of that flight stopping or even slowing down — quite the opposite, in fact — so the viability of the entire system must come into question sooner or later.

Health insurance costs have doubled since 2007 and are expected to increase by between 25% to 30% within two years. This galloping inflation, so out of kilter with other costs, is plainly unsustainable. It may also, according to UCD economist Colm McCarthy, who published a report on health insurance commissioned by Aviva yesterday, threaten Government plans for universal health insurance, promised by 2016.

As is usual and refreshing, Mr McCarthy did not put a tooth in it when he pointed the accusatory finger at the root for this spiral. He blamed excessive healthcare costs caused by too many hospitals paying too much for drugs and salaries that are still, despite cuts, too high.

Government efforts to rein in drug costs have not been as successful as our circumstances demand. Any effort to close any hospital is met with something like a local uprising and efforts — ongoing — to cut health sector salaries are opposed with the most strident threats of industrial action.

Mr McCarthy also warned that a universal premium, irrespective of an individual’s circumstances, is becoming increasingly difficult to sustain, as the demographic balance needed to support it is changing so dramatically.

It seems we are caught in a terrible pincer movement of our own making and that an affordable resolution is out of reach in the immediate term. Pre-election promises about a universal health insurance scheme were vote-winners. It was appealing for financial and social reasons, but the proposal seems to have run into the sand. Nonetheless, in the face of ever more expensive insurance the project must be delivered.

It would be far more reassuring if, after more than two years in office, Health Minister James Reilly’s record suggested he might be the one who could make that promise real.