Further revelations about the Irish health care system came to light last week with the unopened letters and un-reviewed x-rays in Tallaght Hospital. Such behaviour fuels views that the health system lacks efficacy and efficiency and intensifies calls for reform of the health system such as the Fair Care proposal by Fine Gael.
At a recent public meeting Enda Kenny and Dr James O’Reilly used examples of tragic patient cases to highlight the flaws in the current Irish system and presented their Fair Care proposal. Throughout the presentation they outlined how, under a Fine Gael Government, Fair Care would be a new health care system. This system would be modelled on the Dutch health care system which has a mandate for all citizens to have private health insurance, but the hospitals would not be privately owned or run – so not really a model of the Dutch system after all where the hospitals are private and employees are hired by private organisations. Promises such as “free GP”; diagnostics tests performed in primary care and national body tests were made.
The presentation did not however clearly address the elephant in the room – how would this be financed? The presenters conveyed a spirit of infinite resources, which any rational person is not true, particularly in the current climate. The current Government are dealing with a budget deficit of 12% of GDP – this won’t disappear over night with the election of a Fine Gael Government.
At individual level too details of how Fair Care would be financed was scant. The presentation suggested that individuals will continue to pay for the running of the public health care system and for transfer payments through the taxation system and in addition would have to pay private health insurance premiums. These transfer payments would no longer include payments for medical card patients instead will cover full private health insurance premiums for 40% of the population and staggered co-payments for a further 30% of the population. Suggesting the public health care bill will increase even more as will individuals’ health care costs.
Aside from the populist proposals the presentation did identify the root cause of the current problems – the organisation of the health care system. A two-tiered health care system does exist in Ireland which is conducive to creating an equitable health care system. Fair Care however seeks to move everyone to the second tier of the system – the private health insurance tier, yet continue to use the public hospitals. This ignores the underlying problems in the organisation of the system. This will not reduce waiting lists as is promised by the proposers, as it will take the same patients and put them through the same hospitals.
Instead the proposal looks at changing how the system is financed. Currently the majority of the health system is financed through general taxation. Fair Care looks at changing this to mandatory private insurance, like that in the US.
International evidence has shown that tax financing is the most resilient funding source, not private health insurance. Private insurance and even social insurance are both vulnerable to recessions, unemployment and general down turns in the economy, so are not sustainable.
So while Fair Care does promise “free” things and to cut waiting lists perhaps the means of getting there need to be re-addressed. Poor organisation does not mean poor financing. The current financing regime through tax revenue is the most suitable and robust. Future proposals need to focus on reforming the parts of the system which are not performing and acknowledge the parts that are.