AFTER YEARS of failed health reform, the Government assumed power with radical plans to shake up the health service.
Minister for Health Dr James Reilly claimed at a conference last week that reform is already working; thanks to his department’s special delivery unit, emergency department waiting times have been reduced and the number of “same-day” surgical operations has increased, he said.
But others have voiced concerns about details of the reform, many of which are based on recent changes in the Dutch health system. Described by Richard Layte of the ESRI as a health economist’s dream because of its complexity, the Irish health service is dominated by different models of hospital care and a significantly underdeveloped primary care sector. In contrast, the Netherlands has one of the best developed primary care systems, giving it a solid base for reform.
If the Government wishes to follow the Dutch model, it needs to be aware of the gap between policy intentions and outcomes. Advocates of the Dutch system had argued that competition among private insurers would reduce healthcare spending, enhance consumer choice, and improve the quality of care and the health system’s responsiveness to patients. However, since 2006, the total cost of health insurance for Dutch families has risen by more than 40 per cent. The numbers who change provider each year is small, and the Dutch experience suggests that the regulatory role of government has expanded rather than diminished.
There is concern too about certain elements of universal health insurance, the lynchpin of the Government’s health plans; specifically that the population of the Republic is too small to support multiple health insurers. There is also a risk the universal health insurance model may unravel due to rapidly increasing costs.
The Minister of State with Responsibility for Primary Care, Róisín Shortall, has identified a number of notable deficiencies in the health system. Surprisingly, there is still no separate primary care budget within the Health Service Executive nor a national director of primary care. When added to the paltry development of functioning primary care teams and so few primary care centres, much structural development is needed before a universal health model can be significantly progressed.
Health reform is possible and the removal of a two-tier system is admirable. But the Government must listen to those who query the detail of its plans. The State cannot afford another botched reform process.