Universal healthcare was promised but has not been delivered
Analysis from Irish Independent on 21 September 2015
An essential element of this Government’s 2011 promise of a ‘democratic revolution’ was a ‘universal single-tiered health service, which guarantees access based on need, not income’. It committed to do this through universal primary care and universal health insurance.These were radical health policies. If delivered, this Government would have been the first in the history of the State to introduce universal access to healthcare.
Progress towards universal primary care has been delayed and deferred as promises to give GP care without charge to some of our sickest people was never acted upon. Meanwhile, plans for universal health insurance (UHI) are at best on hold as the Government refuses to publish the UHI costings that it commissioned, which show that the UHI model that it proposed is wrong and unaffordable.
This summer, free GP care was eventually extended to our youngest and oldest citizens but no other progress has been made towards extending healthcare coverage. Medical card numbers peaked in 2013 and have been on the decline since and now the same proportion of the population has medical cards as when Fine Gael and Labour were elected.
Despite the intent and commitment to universal health insurance, the most recent measure to bolster the private health insurance market through the introduction of life-time community rating makes the health system less universal.
Penalising people over 35 for not taking out private health insurance demonstrates the Government’s increasing incoherence in policy measures as it exacerbates the two-tier health system that it set out to dismantle.
Amidst these progressively conflicting policies, there has been a conspicuous shift in language from universal health insurance to universal healthcare; yet despite the rhetoric of universal healthcare, the reality is that government measures are mitigating against universalism.
Ireland is unique in Europe, and extremely unusual in a high-income country context, because we do not have a universal healthcare system. The absence of a universal health system means that people are denied timely access to essential health and social care. In fact, it is often more difficult now for Irish people to access care than it was when this Government came to power in 2011.
Take the bottlenecks in our public hospitals, for instance. The Government promised a special delivery to reduce waiting lists and times.
Yet four and-a-half years on, high numbers and long waits on trolleys in emergency departments remain. Trolley figures for 2015 are not worse than 2011 but they are worse than the previous three years.
In 2012, Dr James Reilly introduced a target of nine months for hospital appointments. In 2014, Leo Varadkar doubled the target to 18 months, admitting that it was unambitious but achievable.
While some progress has been made on the very longest waiters (those waiting over two years), their deadlines have passed, the targets were not met. There are now more people waiting for out-patient, in-patient and day-case hospital appointments than there were in 2012.
Despite pre-election promises to abolish prescription charges for medical card holders and reduce the cost of drugs paid by all citizens, this Government increased medical card charges from 50c per item, capped at €10 per month, to €2.50 per item, capped at €25 per month.
Similarly, under the current regime, drug charges for the rest of the population increased from €120 per month in 2011 to €144 in 2013.
New analysis of reduced coverage and increased charges for hospital care and drugs show these increases meant Irish citizens had to pay €551m more out of pocket for essential drugs and hospital treatment in 2014 than they did in 2008. This is equivalent to nearly 5pc of the total public health budget.
Achieving universal healthcare cannot and will not happen overnight. It takes time.
It requires increased money and staff to meet the needs of our growing, ageing population, never mind the high levels of unmet needs. It necessitates investment in timely, integrated health and social care, so that people receive quality services.
While free GP care for under-sixes and over-70s is a small step in the right direction, this Government’s decision to increase drug charges, its inability to achieve reasonable waiting times for hospital care and the introduction of life-time community rating are all steps in the wrong direction.
While Irish Water will continue to attract most of the political heat in the run up to the next election and the Government’s failure to tackle homelessness and build social housing will be the major social-policy election issue, choices made in health are of critical importance.
Government and opposition parties have the power and capability to move Ireland closer to other western European democracies by committing to and progressing towards a system of universal healthcare.
Or they can maintain the status quo, privileging those who are well and healthy over those who are not, by continuing to deny access to healthcare to many of our citizens.
The choice is theirs. However, come election day, the choice will be ours.
Sara Burke is the project co-ordinator of the Mapping the Pathways to Universal Healthcare research project. Early findings from this project will be presented at a seminar in Trinity College Dublin on 22 September 2015. More at https://medicine.tcd.ie/health-systems-research/news/