In Sickness and in health


With problems in the Department of Health leading to delays in plans for implementing universal health care, and insurance prices set to rise, Patrick Kelleher examines the situation we find ourselves in today

Healthcare is expensive. It always has been, and luckily, Ireland is a country where free healthcare is provided for many people. This is not all it should or can be, and it often means long waiting lists, poor hospital facilities, and the shutting down of A&E services. On the other hand, wealthier people can afford private health insurance, allowing them to skip the queue and receive the best medical attention possible. While the public healthcare situation is in such a dire state, private insurance companies profit from those who can afford extra healthcare.

The recent resignation of Roisin Shortall as Junior Minister for Health shows just how serious the problems of the Department of Health are. Her resignation was down to Health Minister James Reilly’s refusal to deal with ‘big ticket issues’. This shows a major problem with the health service, and it seems that even our Government representatives cannot formulate a solution to the problems Ireland is encountering.

Private health insurance has been around for a long time. It was a way for people who had more money to avail of better healthcare from more expensive doctors. It is advantageous for those with the money, but what about those who can’t afford it? Should they not be entitled to the same health services that other citizens are? It is, after all, a human right.

The problems with our health insurance policy are numerous. The most detrimental of these is that it has created a two-tiered society; one in which those with money can get better health service than those who are not as privileged. It separates people into classes: the ‘private healthcare’ and the ‘state healthcare’ groups.

It’s undeniable that there is a need for change and recent statistics prove this. Since the recession hit, the numbers of people availing of health insurance fell drastically. In the two years from June 2010 to June 2012, 100,000 people dropped their health insurance. Over 16,000 of these alone dropped their insurance between the end of March and the end of June of this year. Since December 2008, there has been a decline of 7.6%. A clear pattern emerges from these figures: people just can’t afford health insurance anymore. Increasingly, families are struggling to put food on the table, let alone pay a health insurance bill every month.

This is on top of the fact that health insurance costs are set to rise, although it’s not clear yet by how much. This is because, from January 1st 2013, a new risk equalisation scheme is to be put in place, which, according to the Health Insurance Authority (HIA) is a process that seeks to neutralise the cost of health insurance across all age profiles. It will mean everyone with health insurance will pay the same price. It is understandable that families are getting worried about paying that bill, especially when there’s still uncertainty surrounding the cost of this monthly bill in January.

In the meantime, health insurance companies are profiting from the hardship of others. Yes, in return for money they guarantee better healthcare, but is this enough? Everyone pays taxes, and money from those taxes funds the public health service. What’s happened in Ireland is that people with insurance are paying two charges: their private health insurance and also the public health service. The latter, in theory, is one that they have little reason to use.

It’s obvious to anyone who knows of the funding crisis surrounding the public health service that something needs to be done, and many things need to change if there is to be a health service that caters equally for everyone and one that is provided by the state. It is perhaps for this reason that the Government are looking to set up a universal health insurance system. This system would seek to give everyone in Ireland the same health coverage. It would mean no queue jumping and no special treatment because a patient has more money than another. Those with less money would pay a small premium, and those with more money would pay a bigger fee.

However this system may pose problems. A similar system was adopted in the Netherlands in the 2006 health reforms, and according to the National Secretary of the IMPACT Trade Union, Louise O’Donnell, the move was poorly thought out. It created a three-tier system, and had left half a million people uninsured or defaulting on insurance payments. Despite this, the Dutch system was ranked as being the best healthcare system in Europe in the 2009 Euro Health Consumer Index (EHCI).

This leads to the question of what should be done about the Irish health service. It is clear that the move for universal health insurance is a strong one, and has been motivated by the desire to decrease the influence of the money making racket that is private health care. On the other hand, the system could potentially be a failure, with the main issue being that many people can’t or won’t pay the premium they’re supposed to, leaving the system in a funding crisis.

Despite the dangers, universal health insurance still needs to become a reality. The health service in Ireland at the moment is not viable, and it is time to embrace change. A new system is always going to be a risk, but one thing is for sure, it can’t be much worse than the two-tiered system we have now that favours the rich over the poor.