Delivering free primary care to all adults to refund medical expenses such as GP visits, prescriptions and dental fees could be done in the term of a new government through a reformed PRSI/Universal Social Charge system, Minister for Health Leo Varadkar has said.
Speaking at the MacGill summer school in Glenties, Co Donegal on Thursday, Mr Varadkar said he would like to find a different way to cover those who were not already covered for free access to primary care.
Mr Varadkar said that with rising employment, falling unemployment and rising wages, this was affordable.
“It could also be a major step towards a single-payer social insurance based system with payments to providers, or refunds to patients, administered by a new single payer.”
He said another way of achieving the same outcome would be to introduce universal health insurance for primary care first, using a “multi-payer” system, and giving people the option to pay for it through social insurance or to opt out in favour of a new or existing private health insurance policy that offered the same or better.
The Minister said the funding and financial systems were not in place to extend universal healthcare to hospitals at present.
“I think extending it to hospitals is actually very difficult. We don’t have the funding or financial systems in place yet, we don’t have enough specialists, we don’t have enough capacity actually in our hospitals to provide quality universal healthcare, but we could build up that capacity over the next five years.”
Universal health insurance is the Government’s main policy for reforming the health service. It would aim to abolish the existing two-tier system with a single tier system by effectively making everyone a private patient.
A confidential report prepared for the Government recently suggested that the annual cost of universal health insurance (UHI) to cover a standard package of benefits for one adult could be between €2,000 and €3,000.
This is far higher than had previously been estimated and is likely to further call into question the viability of the policy as it was first envisaged.
A more comprehensive series of benefits could cost between €3,000 and €4,000 a year.
As expected, Mr Varadkar also announced on Thursday the extension of GP care, first to children under 12 and then to children aged 12 to 18. He said 91 per cent of GPs had now signed up to the contract to deliver free care to children under six.
Mr Varadkar said he would not like to see GPs and other primary care employees becoming HSE employees and that their strength was that they were independent.
Delivering his address, the Minister also said a new scheme to reduce the out-of-pocket cost of medicines was required. He said the current maximum amount of €140 per household per month for prescriptions was “just too much and falls very heavily on single-person households”.
He said the €2.50 prescription fee was also too high.
Mr Varadkar said the current administrative structure for hospitals needed to be replaced with a clear statutory one and hospitals need to be able to recruit managers and specialists outside public sector rules. It was his strong view that this should be done within the first two years of the next Government.
Mr Varadkar said a “crucial and deliverable reform” was the ending of any preferential access for patients with health insurance in public hospitals to theatre, admission, a specialist opinion or diagnostics.
“Health insurance should get you a nicer room and other hotel-style benefits in a publicly-funded hospital, but nothing else,” he said.
Varadkar also said he hoped the planning application for the new national children’s hospital would be lodged this month with a view to having it under construction by February of next year.
He said he would not be going on holidays until it was lodged and he had told his officials they would not be going on holidays either.
