The Government's agreement with the Irish Medical Organisation to provide free family doctor care for children aged under six has been heralded as a "tangible" step towards universal healthcare in this State. Citing this initiative, combined with an extension of medical cards to everyone over the age of 70, the Minister for Health, Leo Varadkar can attest that a firm foundation on the road to universal care has now been laid.
Subject to the participation of individual GPs, some 270,000 children stand to benefit from the new scheme. They will undergo height and weight checks at age two and five, as well as free episodic care. Doctors will be paid a yearly capitation fee of €125 per year for each child under six. The total cost of the new scheme, including additional elements for children with asthma and a specific care package for people with diabetes, is estimated to be in the region of €90 million annually.
In truth, the announcement is something of a curate’s egg. Full universal healthcare will involve those with higher incomes paying the equivalent of an insurance premium, yet parents of substantial means are set to gain to the same degree as those on modest incomes under this free family doctor initiative for the under sixes. In some ways the most progressive aspect of the announcement is the new ground it breaks in the area of chronic disease management. By offering additional income for the management of children with asthma and patients of all ages with type 2 diabetes, for the first time GPs will be incentivised to take on specific aspects of improving the care of people with chronic illness.
A number of questions remain as yet unanswered. Will family doctors have to reach certain treatment targets for the full additional fee to be paid? And has the Department of Health allowed for the substantial workload increase the new schemes will bring to an already under -resourced primary care system? The devil may well be in the detail of a potentially progressive initiative.