Many members of the public fear Government plans to introduce universal health insurance could cost them money or lead to them losing existing benefits, a confidential consultancy report has found.
The report, commissioned by the Government, says that while there is broad public support for reforming the health service and introducing greater equity of access, many people are critical either of universal health insurance in principle or of the particular model which has been put forward.
The report also finds some people are concerned universal health insurance would just represent another form of indirect taxation.
The Government last year began a public consultation process around its plans to reform the Irish health service. It said it wanted to end the existing two-tier public/private healthcare system and replace it with a new arrangement under which everyone would have to be covered by health insurance provided by competing insurers. Under universal health insurance, everyone would be a private patient and would enjoy equal access to healthcare.
Nearly 140 individuals, groups and organisations made submissions on the Government’s plans.
The Department of Health subsequently commissioned consultancy firm Crowe Horwath to carry out an analysis of the views submitted. Its report, which has been seen by The Irish Times, says a number of respondents are concerned at the potential costs of the proposed system and have cast doubt on whether the benefits would outweigh the costs.
Substantial costs
It says respondents are unhappy at the apparent lack of additional resources earmarked to cover the anticipated substantial costs of the proposed reforms in the light, particularly, of the €180 million start-up cost for Irish Water.
“Additionally, respondents were apprehensive about the ongoing costs of operating the proposed new structures and delivery of health services.”
It says some people linked these concerns to evidence of rising costs under universal health insurance emerging from the Netherlands and other countries where similar systems are in place.
The report says a key and repeated concern among some respondents who currently have private health insurance is that they would end up paying potentially similar sums under the new system but lose out on their current benefit of having faster access to healthcare.
“There is concern among respondents that those paying for private health insurance now will pay universal health insurance for what may constitute a lesser service, in particular in terms of the perceived ability to access care in a timely fashion, but also the choices perceived by respondents to be offered by private health insurance in terms of choice of healthcare provider (both in relation to institution and consultant) and in terms of choice of accommodation (lower occupancy rooms),” the report says.
Concerns
“Participants also had a number of questions and concerns surrounding the potential cost of universal health insurance to individuals and households, in terms of standard premiums, the level of financial subsidy for those on low income, the thresholds for such subsidies, the possibility of supplementary insurance requirements to access particular services, co-payments and out-of-pocket expenses and the potential for universal health insurance to cost individuals and households more as time goes by.”
The report also says respondents are worried at the potential impact of universal health insurance on those who currently have medical cards.
“A key concern mentioned by participants is the lack of detail in relation to what extent the current medical card and other entitlements . . . will be maintained for those on medical cards and/or whether and how much they will be required to pay under the new system.”
The report says some people are concerned the planned introduction of mandatory universal health insurance would remove choice from the individual as to whether they wanted to pay for such an arrangement.
The report says there is some limited support from private health insurers in particular for implementing an insurance-based structure for achieving equity of access.
“However, there is a clear demand for greater clarity and more detail on how universal health insurance might be implemented – often, those who have indicated general support for the concept of universal health insurance have been reluctant to go further, citing a lack of clarity on how universal health insurance would work in practice.”
