Consultation – A National Conversation on UHI

On 2nd April 2014, a major consultation process on the White Paper on Universal Health Insurance (UHI) was launched.  The Department received 137 submissions from a wide variety of sources, including patient advocacy groups, private individuals, health service providers, not-for-profit organisations, private health insurance providers, academics and others.

Following a procurement process, the Department asked Crowe Horwath to carry out an independent analysis of the themes and main messages arising from the consultation.  Their report, Thematic Analysis of Submissions in Response to a Public Consultation on the White Paper for Universal Health Insurance, summarises the main messages from respondents under 19 themes.

The report notes that there is broad welcome for the Government’s aim to reform the health service to bring about a single-tier health system with equity of access, i.e. universal healthcare.  However, it notes some concern regarding the specific model of UHI and the impact which UHI may have on private health insurance policyholders and the private health insurance market generally.  To this end, it is worth re-emphasising the Government’s overall objective of delivering timely access to care for everyone in a more efficient, well integrated single-tier system- a system that improves patient outcomes for everyone, a system that delivers value for everyone, a system that works for everyone.  In line with this overall objective, Minister Varadkar is committed, in the first instance, to ensuring the development of a vibrant, sustainable private health insurance market.  The Minister announced a package of measures in late 2014 designed to encourage the greater take up of private health insurance in 2015 and thereafter.

The Minister notes the concerns expressed by some respondents regarding the timeframes for the introduction of UHI as set out in the White Paper.  Having reflected on these timeframes, the Minister, as he made clear in July 2014, determined that, whilst progress had and was being made, the original timeline for full implementation of UHI was too ambitious.  That said, he made clear his commitment to implementing the major programme of health reform as set out in the Programme for Government. He is committed to pushing ahead as soon as possible with key reforms such as the phased extension of GP care without fees, the establishment of Hospital Groups, the implementation of activity-based funding and the improved management of chronic diseases.  These are all major milestones on the road to universal healthcare and will be amongst the Minister’s key priorities for 2015.

While there is widespread support for the aim of a single-tier health system, some respondents to the consultation queried whether the role of supplementary insurance could result in a continuation of a two-tier system whereby those on higher incomes will be able to access more.  The Minister would like to reaffirm that under UHI everyone will have equal access to timely healthcare, based on need and not ability to pay.  Supplementary insurance will have a limited role related solely to services falling outside the standard UHI package (e.g. purely cosmetic surgery or alternative therapies) and non-health care services (e.g. the availability of in room entertainment systems).

The Minister also wishes to respond to concerns regarding the influence of insurers on healthcare decisions. He would like to reassure respondents that, as at present, treatment decisions will remain vested in healthcare professionals.  He would also point to the independent adjudication process set out in the White Paper which will provide a quick, low cost resolution mechanism in cases where there is a dispute between an insurer and a policyholder over the interpretation of the standard UHI package.

Finally, a key issue raised within the consultation process is that of cost.  A major UHI costing exercise is currently underway in conjunction with the Economic and Social Research Institute, the Health Insurance Authority and others. The first results of this work are expected in April 2015.  Informed by both the results and the feedback from the consultation process, Minister Varadkar will then bring proposals to Government regarding the next steps on the road to universal healthcare.

The Minister is grateful to all those who submitted their views.  Respondents have provided a rich body of material which he and the Department will continue to study carefully as an important contribution to the debate on the future of our health service.

Final Report to the Department of Health – Thematic Analysis of Submissions in Response to a Public Consultation on the White Paper for Universal