Sir, – The ESRI report on universal health insurance claims that an "extension of coverage for young children will facilitate the roll-out of new public health measures, such as wellness checks, at relatively low cost to the exchequer and very low cost to Irish society, when the removal of private fees for this grouping is taken into account" ("ESRI calls for Government to extend universal healthcare", June 16th).
However, “wellness checks” have no evidence base whatsoever to support their efficacy. They are the archetypal medical intervention that is excessively liable to the “inverse care law”, ie that healthy, middle-class, well-educated people, who are the least likely cohort of patients to benefit from the checks, are the most likely cohort to avail of them. Given the lack of evidence to support the efficacy of these checks, the claim that they come at a relatively low cost prompts the question, relative to what?
The report also claims that people who currently pay for private health insurance are “likely to be among the potential winners from universal free GP care”. This completely fails to recognise that, should the roll-out of universal “free” GP care continue, their ability to access this resource in a timely manner will be severely curtailed, as evidenced by the dramatic increase in attendances since the introduction of the under-six medical card and resultant crowding out of appointment slots.
Without dramatically increasing the number of GPs in this country, which is pitifully low by international standards, universal “free” access will automatically lead to significantly longer waiting times for appointments for all patients, with consequent strain on our out-of-hours and emergency services and the continuity of care that is the cornerstone of general practice. – Yours, etc,
Cllr Dr PADDY SMYTH,
City Hall,
Dublin 2.