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Extending tax-financed system could help universal healthcare

24 Jun 2016

Within primary care, universality could be advanced by extending the present tax-financed system, the Economic and Social Research Institute (ESRI) has said.

And within hospital care, universality could be advanced by either a new public purchaser of hospital care or by introducing compulsory private insurance for elective hospital care, the think tank has stated.

The model of Universal Health Insurance (UHI) proposed by the last Government could have increased costs without achieving universality and equitable access, an ESRI report published last week found.

Although coverage of GP care free at the point of delivery was extended to young children and re-instated for people aged 70 and older, other measures taken by the last Government “reduced the dimensions of universality in the Irish system”, concluded the ESRI’s Budget Perspectives 2017 paper by authors Dr Maev-Ann Wren and Dr Sheelah Connolly.

According to the report, ‘Challenges in Achieving Universal Healthcare in Ireland’, future health policy should aim to increase universal healthcare coverage (population coverage, services coverage and pooled payment to replace user fees), “while building from the existing Irish system in the most cost-effective way possible”.

The report — which was critical of the abandoned 2014 White Paper proposals for UHI — examined the rationale and the requirements for achieving universal healthcare, which the World Health Organization (WHO) advocates as the most effective means of improving global health.

The ESRI examined the extension of the present tax-financed primary care system. It addressed two-tier access to hospital care — by either a new public purchaser of hospital care or introducing compulsory private insurance for elective hospital care, in a system “designed to ensure payment according to ability to pay and Government control of insurers’ margins and other costs”.

Universal healthcare systems aim to remove financial barriers to accessing care by creating a pre-paid pooled fund or funds, whether by taxation, social insurance or, less commonly, with a central role for private health insurers.

The financing mechanism is “secondary to the objective of universality”, stressed the report.

It added that the extent of universal coverage depended on the proportion of necessary services that were financed from the fund, the breadth of population coverage and the extent of out-of-pocket payments to access necessary healthcare.

While full population coverage was envisaged in the UHI model proposed in the 2014 White Paper, there was uncertainty about the services and costs to be covered by the insured standard package and about the level of out-of-pocket charges, thereby “undermining the universality” of the proposed model.

A system of universal healthcare should be designed to ensure payment according to ability to pay and Government control of insurers’ margins and other costs.

Commenting on the paper, Dr Wren said: “Any proposed reform should be subject to rigorous cost-benefit analysis, which would assess the costs of the system change relative to the potential gains in health outcomes, equity and system efficiency.”

gary.culliton@imt.ie

Gary Culliton

Click here to view the full article which appeared in Irish Medical Times