Universal health insurance (UHI) was to be the centrepiece of the Government’s ambitious health service reform plans.
The proposed new system to end the existing two-tier health service was championed strongly by the former minister for health James Reilly and by Taoiseach Enda Kenny.
However, the Department of Public Expenditure and Reform expressed concern that the initiative could be unaffordable and suggested that cover could cost over €1,600. This was seized on by the Opposition who described the plan as just another tax.
The Irish Times reported last August that after Dr Reilly departed, officials in the Department of Health told his successor Leo Varadkar that the health service reform plans were "unworkable".
Mr Varadkar subsequently said he was delaying the introduction of UHI, which had been scheduled for 2019.
Two-tier system
Under the proposal, the controversial two-tier health system currently in place would be swept away and the practice of queue-jumping for treatment by people who could afford to pay or who have private health insurance would be ended.
It would be mandatory for all to have cover for a basic package of services – known as a basket – from one of a number of different insurers.
The State would pay the premium for the lowest income groups and provide subsidies for others.
People who refused to take out cover would have it provided for them, with the cost deducted at source from their earnings or benefits.
The precise details of what would be covered under universal health insurance were not set out by the Government pending a public consultation process. But the Government suggested a “preferred” basket of services which could be covered in the standard package.
These include universal primary care, including core GP and community nurse services and the maternity and infant care scheme.
Chronic disease
Acute hospital care – including all inpatient, day case and outpatient care – would be covered, as would chronic disease and care management for those who met specific clinical criteria.
The “preferred” package would also cover acute mental healthcare, including those services provided by community mental health teams in outpatient clinics, day hospitals, day centres and acute inpatient facilities, for not more than 12 months.
The proposals would permit people to take out supplementary health insurance to cover areas not included in the standard package. This would include private rooms in hospitals.
However, for the first time, this supplementary insurance would be provided on a risk-related basis rather than on a community-rated basis, where everyone paid the same for identical products, regardless of age.
This meant that as people got older, the price of this supplementary cover would increase significantly.
