Independent experts’ report shows that primary care strategy is not being implemented to any great extent
FOR YEARS there has been much talk about the need to move more healthcare out of hospital environments and into the community setting, where it is less costly and more accessible to patients.
The merits of doing so are obvious and were spelled out clearly in the national primary care strategy, published by the government back in 2001.
But the shift has not really happened to any great extent, and GPs claim that even when some services are moved out into primary care, the money that funded them remained stuck in hospitals.
A new report from an independent expert group confirmed this yesterday, pointing out that the money for healthcare that is in the system is not following the patient at present “despite the widespread commitment to integrated care pathways linked to phrases like ‘the money should follow the patient’”.
It says the ways resources are allocated “actively encourage care in less appropriate settings”.
And the manner in which entitlements to healthcare are structured hinders attempts to shift the balance from hospital to community care. For example, everyone in the State is entitled to free or subsidised care in a public hospital, but two-thirds of the population have to pay for GP care, including some people who are on relatively low incomes and who are not going to their family doctor as often as they need to.
This risks letting smaller problems develop to a stage where more costly medical interventions are required.
The report sets out a framework to address this, noting that Ireland is unique compared to other developed countries in not having any direct public subsidy for GP services.
It suggests everyone in the State should have some form of subsidised GP care. Everyone would get a primary care card. There would be four types of card, with people on the highest incomes having a basic card which would entitle them to GP visits for a flat fee of €40 (which would be lower than many now have to pay) and 80 per cent of the costs of their drugs up to a maximum of €95 per month. Those on the lowest incomes would essentially get a card that would allow them get GP visits and drugs free, like under the current medical card. But this card would also cover those currently on the long-term illness scheme except it would cover a wider range of established chronic diseases.
Charles Normand, professor of health policy and management at TCD and one of the expert group members, insisted no one would be worse off as a result and many more would be better off.
On the face of it this seems like a good idea and would bring greater equity into an inequitable and unfair system, particularly for those just above income limits for medical or GP visit cards.
If the new system is implemented – and Minister for Health Mary Harney says she is open to all its recommendations though she is unlikely to be too pleased at its denunciations of her plans for prescriptions charges for medical card patients – patients should be encouraged to seek medical help earlier, which would be a positive development.
But will it be implemented? That remains to be seen. There are a number of hurdles to be crossed first. There would have to be agreement with GPs on new graduated capitation payments for all those covered by primary care cards, and of course there’s the issue of too few GPs in some areas to cope with demand, not to mention the increased demand that would be created by the new scheme.
In addition, the €513 million cost of the reforms will have to be funded from within the health budget, which is likely to be cut again next year.
But the report’s authors believe the new system can be funded from savings generated through greater efficiencies in the hospital sector and the abolition of tax breaks already in the system – something the Department of Finance is resisting. Given these early disagreements, whether the changes will be made to happen and when is anyone’s guess.