Health services - A chance to define a new, fairer Ireland

ABOUT half of the population is covered by private health insurance but the proportion is falling.

Reduced incomes, unemployment and spectacular increases in premia mean that very many people can no longer afford the security, real or imagined, that private health insurance represents. This is a considerable blow to the psyche and self-image of middle-class Ireland.

Still more people have decided to reduce their cover, though dearer premia — up to 40% in some instances — may mean that their bill remains the same but they have been forced to settle for less cover.

In 2009, VHI lost 112,000 customers and a further 50,000 last year. This trend continued in the first quarter of the year when 14,000 subscribers — and possibly many more if their dependants are considered — decided not to continue paying for inpatient health insurance.

Though this situation could become a considerable extra burden on an already stretched public health system it is a smaller fall than that recorded in the same period in 2010 when 17,000 subscribers reduced or cancelled cover. Like so many facets of Irish life, our health service funding is caught in a vicious, debilitating circle of soaring liabilities but tumbling incomes.

Generations of Irish people were prepared to pay to get the kind of health service that should be universally available in a country as wealthy as this. That so many did was an indictment of our health system but it was even a greater indictment of the political system that allowed such an unfair system to prevail; a system where a person’s prospects of treatment were defined by the revenue they might generate for private health services.

It sustained a two-tier system where your financial circumstances had a defining influence on your prospects of immediate and effective treatment.

The immorality of this situation was seen at its cruellest in the sad case of Susie Long. On the day her cancer was diagnosed, another person in the same surgery was also diagnosed with cancer. Ms Long opted for public treatment and before it was provided, her cancer had advanced to the point that it led to her death. The other person was in a position to seek private care and survived the ordeal.

Health Minister James Reilly has declared that he intends to change this situation, that he intends to confront the sectional interests who make our system so inefficient, so very expensive and so inflexible. This week he opened talks with hospital consultants on designing a new contract. The present contract is the result of a tortuous few years when the consultants and the then Health Minister Mary Harney danced around issues as if there was no tomorrow.

Dr James O Reilly does not have that luxury. As tens of thousand of workers at the bottom of the ladder face pay cuts because arrangements protecting extra pay for weekend work might be scrapped, there is an urgency about confronting these issues.

A universal health insurance scheme should be one of the building blocks of a rejuvenated and more equitable Ireland. Apart for the provision of health at all it could be a symbol of a renewed society where our health service is as good as any in Europe and where the expectations of powerful interests take second place to the needs of patients.


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