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An Irish blueprint for healthcare reform

Most EU countries are struggling to cope with major structural re­forms that have become both urgent and important for future economic prosperity. Long-term and youth unemployment, underperforming educational systems, as well as increasingly dysfunctional health systems are a few of these top priorities.

After the metaphoric death of the Celtic Tiger business model, the Irish government has managed to win back respectability in the financial markets. It is now determined to tackle more socially sensitive issues that can make a great difference to ordinary people who were so badly battered by the austerity of the last six years.

The reform of the health system is one of the top priorities. Healthcare in Ireland is two-tier: public and private sectors co-exist. Almost 70 per cent of Irish people do not qualify for free healthcare as they do not have a medical card. While medical services in the public health sector are subsidised, Ireland spends €2,862 per capita on health, compared with an EU average of €2,172. The large private sector health market is booming but is far too expensive for most people.

This is about to change as the Taoiseach (Prime Minister) Enda Kenny has announced that by 2019 Ireland will have a universal health insurance that covers all Irish people. Ireland has some of the best medical and paramedical staff in the world. They also have good healthcare management traditions at the operational level, but years of neglect at the strategic level has meant that the health system is no longer fit for its purpose.

The usual symptoms of strategic failure are evident: long waiting lists, patients waiting on trolleys until beds are found, and the tragic deaths of babies in Portalaoise Regional Hospital because of strained resources have recently focused attention on the need for reform.

Health Minister James Reilly fully backs the reforms: “Some have argued that we cannot afford universal health insurance. My answer is simple: we cannot afford the current system, even after all the savings we have made over that last few years. The present system is unfair because it has created a health service that treats some people differently than others. If you cannot afford private insurance, you may have to pay a much greater cost – waiting for treatment in a health system that is badly designed and struggling to meet demand. Just like justice, healthcare delayed can mean healthcare denied.”

What I find even more convicing in the Irish government’s approach to this strategic issue is the sense of urgency that is evident in the political communication

The introduction of a universal health insurance will be a major change in Irish politics that in the past steered away from providing the extent of benefits that one usually takes for granted in a welfare state. The electorate will need strong doses of convincing arguments to back these radical changes.

The government wants to engage in a “national conversation” about reform of the health services. One tactic that they will adopt is the publication of a White Paper on universal health insurance. Some details are already beginning to emerge. People on low income or unemployed, as well as those unable to work, will be exempt from paying an insurance premium. The introduction of the new system will be staggered over a period of five years so that the private health market can adapt.

Getting public support for this major change is a critical success factor for this project. So is the clear definition of the vision behind this proposed change. The Irish Health Minister declared: “Our universal health insurance will ensure that everyone is treated the same – getting the healthcare they need, when they need it, and where no one is denied care because they can’t afford it. Doctors and nurses are given both greater freedom and greater responsibility, so that they can deliver the kind of safe care that we – and they – all want.”

What I find even more convincing in the Irish government’s approach to this strategic issue is the sense of urgency that is evident in the political communication. The Irish Prime Minister played on the emotions of the Irish: “It is hard to believe that just two years before we commemorate the centenary of 1916 (independence), too often too many of our people are treated not on the basis of medical needs but on the basis of income, on the basis of whether or not they can afford private health insurance; a basis that is and should be repugnant to the people of a still-young Republic.”

The Irish blueprint for healthcare reform is certainly worth studying.

johncassarwhite@yahoo.com

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