The health service needs to change and now is the time

IN his recent thoughtful article on Universal Health Insurance published in the Irish Examiner, Ray Kinsella acknowledges that the Department of Health has “undertaken a huge volume of preparatory work” to underpin the introduction of UHI.

However, he argues that now is not the moment for radical reform of the health system. It is a time, he states, “to work with what is in place”.

I respectfully disagree.

I believe that now is exactly the time for fundamental reform of our health service. The current two-tier model of healthcare is both unfair and unaffordable.

Unfair, because it gives certain people faster access to care on the basis of their income rather than their medical need.

Unaffordable, because it is inefficient at best and dysfunctional at worst.

To leave such a system in place would, in my view, be nothing less than a betrayal of the Irish people.

We also know that real reform tends only to happen at a time of crisis. Look at what occurred during the last decade or so of the Celtic Tiger. Spending on healthcare quadrupled. Yet no meaningful reform was introduced. Why? Because the answer to every problem was to shovel more and more money into a system that just wasn’t working. So waiting lists soared even as spending increased. I think the lessons of history are clear. If we don’t reform our health system now, I very much doubt that meaningful reform will happen in the future.

Mr Kinsella also questions the Government’s timeline on reform, arguing that the introduction of UHI is already delayed. In fact, we have accelerated the proposed timetable for UHI.

I am on record previously as stating that the full introduction of UHI would take 10 years from the moment the current Government came into power, ie that UHI would be in place by 2021. The white paper just published states that full UHI will now be introduced by 2019.

Some may argue that even this new timeline is too slow. However, the reality is that we are moving very quickly by comparison with healthcare reform programmes in other countries.

In the Netherlands, for instance, it took them 19 years to introduce their model of UHI — and they were starting from a more advanced position than us. Despite this, I am confident that we can introduce our model of UHI in just eight years.

In the UK, it took 16 years to establish foundation trusts, basically groups of hospitals and other providers who are given greater financial and operational autonomy. We plan to make similar changes to the way our hospitals work in less than half that time.

It is important to understand that UHI was always intended to be the last stage in a three phase process of reform.

Phase 1: The goal of this stage of the reform process is to make the current health system both more efficient and higher quality so that the cost of healthcare, when UHI is introduced, is significantly lower.

Progress to date has been significant. Over the last few years, there has been a 20% cut in health spending and a 10% cut in staff numbers, despite an 8% increase in the population. The health system in other words has become much productive. And more can and will be done.

But the real test of any health system is how it treats its patients. The good news is that more people are being seen more quickly. The number of people on trolleys has, for instance, declined by a third since we came into power. The number of people waiting for inpatient treatment for over eight months has fallen by 95%, while the number of people waiting on outpatient waiting lists for over 12 months has been reduced by 99%.

While this progress is very welcome, it’s clearly not enough. I know many people with private health insurance are worried that they will be placed into a system of common waiting lists under UHI which will force them to wait longer for treatment. However, I want to deliver a situation where waiting lists are so low that no one has to worry about long delays for vital treatment. That is why a new plan will be published over the next few months to show how we will make long waiting lists a thing of the past by the time UHI is introduced.

Phase 2: These reforms, which will be rolled out over the next two years, will see major structural change in our health system. Our goal is to put all of the main building blocks in place for Universal Health Insurance by 2016.

Health reform legislation will replace the HSE with what is called a purchaser/provider split. A new Healthcare Commissioning Agency will be established to act as a strategic purchaser of high quality services for patients. An independent Healthcare Pricing Office will also be established to help drive down the price for medical procedures in Ireland, which are currently some of the highest in the OECD. The Pricing Office has already been established on an administrative basis within the HSE.

At the same time the public providers of healthcare services will be reorganised into a series of new and more effective provider trusts. The regulatory and patient safety structures overseeing the health system will also be strengthened. A Patient Safety Agency will be established, to act as a champion of the patient, while the powers of both the Health Insurance Authority and Health Information and Quality Authority will be significantly strengthened.

Phase 3: The final phase of reform will be the rollout of UHI, including the delivery of free GP care at the point of access.

The model of UHI agreed by the Government is a multi-payer system where everyone can buy insurance from competing insurance companies. The State’s role will remain crucial, however.

Everyone on a medical card will have their insurance paid for while the State will subsidise those on low and middle income. The majority of funding, unlike the Netherlands for instance, will continue to come from general taxation while public hospitals will remain in state ownership.

THE publication of the White Paper on UHI last week was the first, absolutely vital step in the rollout of UHI.

There will now be an extensive consultation process with the people of Ireland on the basket of services to be provided under UHI. An expert commission will oversee this process and deliver a series of costed options for the basket by early next year, for review by the Joint Oireachtas Committee on Health and final decision by the Government.

Very understandable concerns have been expressed about the potential cost of UHI. That is why the Government has made a firm commitment that the cost of healthcare under UHI will not be more expensive than the two tier system it replaces. In fact, I believe UHI will deliver cheaper healthcare over the long term.

People with private health insurance currently pay an average €920 per year. Had UHI been in place in 2013 I am confident that the average price of insurance would have been lower, as a result of the efficiencies that a new single tier system can deliver.

Crucially, people on medical cards would have paid nothing while those on low income would have seen their insurance heavily subsidised. In fact, when you include free GP care, it is clear that many of these people would have been better off.

I believe that the rollout of UHI presents us all with a once in a generation opportunity to create a truly world class health system in Ireland. A health system which is fit for purpose in a modern citizen focused republic. The model of UHI contained in the white paper is neither Dutch nor German. It is a distinctly Irish model of UHI which, while incorporating best practice from a number of different international models, has been designed to meet the unique circumstances of Ireland.

To those who say we cannot afford UHI, I say we can’t afford to keep the current system. To those who say UHI is not the way forward I say — what’s your alternative proposal? And to those who say we cannot or should not reform our health system right now I say — if not now, when?