Women Mean Business - Summer, 2014

Posted by Jill Kerby on July 30 2014 @ 09:00



By Jill Kerby



If you think trouble is brewing over implementation of free GP care for the under sixes, just wait until the Department of Health tries to roll out the same ‘free’ care for adults and, by 2019, compulsory health insurance for everyone.

With expectations as low as they are about the success of the ‘consultation’ process between the HSE and general practitioners on the revised contract they are expected to implement this summer, it’s hard to imagine that under-resourced GPs will be very keen on extending free treatment to the rest of us.

Existing child and adult medical card holders, they claim, are losing their entitlement to free care at the expense of mostly healthy children. The volume of extra work involved in treating all 420,000 children under six will be impossible based on current resources, they say, and certainly not for c€74 per child, per annum.

I have a lot of sympathy for primary care doctors and other practitioners who run their own businesses. I’m also a lifelong supporter of health insurance, especially the bonkers community rated kind that used to be cheap but was always unsustainable without a steady stream of health, young customers.

Now that both models are disappearing, we all need to come to the realisation that healthcare is only going to become more expensive…a lot more expensive.


Wonderful care

The two GPs who have taken care of me and my family for 20 years (one was a GP paediatrician who I took The Child to when he was little) have provided wonderful care for just €50 a visit.  I can’t remember the last time surgery fees went up, but it hasn’t been since the Celtic Tiger suffered its massive heart attack.  Meanwhile, health insurance prices, mainly dictated by state imposed costs, have doubled.

One thing is apparent at most GP practises:  they don’t employ the same number of ancillary staff as they once did, such as a part or full-time doctor and practice and staff nurses. Since my GP is just down the road I can only assume that his light and heat bill and his bin charge has gone up, just like mine.  I also presume he has to pay rates on his (albeit residential-type) premises on top of equipping his practice, paying liability insurance and corporate tax, all on a budget that has seen an HSE payment reduction of 38% in the past four years.

As one Galway GP recently wrote in her blog, the Government wouldn’t deign to treat private sector hairdressers the way they do private sector GPs, who under the new, revised primary GP contract must now absorb another 240,000 children aged under six for a single, annual payment, regardless of whether they are equipped or able to do so.

If the GP’s do not sign the revised contract, they’ll lose their existing GMS (general medical service) child patients, warn the government. All this will do, say their representative organisations, will be to encourage older doctors to retire sooner, encourage younger ones to immigrate and force the struggling ones to go out of business. (About 100 are already insolvent, said National Association of General Practitioners last spring when they conducted their town hall meetings around the country.)

I’d like to think a reasonable solution could be found. But if the worst happens – and remember this is just a rehearsal for the real fireworks show if and when universal GP care and universal health insurance is rolled out in 2019 – every parent of a child attending a GP (with or without a medical card) who has refused to sign will have to pay up. And that fee is likely to be higher for every patient, and may even have to be a different fee, warn some GPs, depending on your age and state of health.

Is there time to pull everyone back from the brink? Is there time to convince the government to re-think the way it intends to deliver health services in the future?

I’m guessing, no.

The Department of Health has convinced the cabinet that the introduction of ‘free’ GP care is necessary for all children and adults in the run-up to the 2019 when under Universal Health Insurance, the payment of that cover switches from direct subvention by the HSE to private insurance companies under the regulation and supervision of seven new health quangos. 

This makes so sense:  between now and 2019 the government intends that everyone will have primary care paid for by the state, even those among the two million health insurance members whose GP fee is covered in part or full by insurance plan.  Then, from 2019, everyone who had their GP treatment paid directly by the state from 2014 will have to buy a private health insurance plan… that will pay for their GP care. Previous medical card holders will receive a subsidised or free policy.

What would make more sense, of course, is for the government to encourage greater voluntary take-up of private health insurance now, by re-instating full tax relief on premiums; lowering the health insurance levy-cum-subsidy to its wholly-owned and unregulated, undercapitalised insurer VHI; ending the arbitrary pricing of public hospital beds for private health insurance customers (which now costs €830 a night instead of the standard €75) and by privatising the VHI in order to encourage more health insurers in the market.


The Canadian model

If primary care, like hospital treatment based entirely on need is the goal of this government, perhaps we should be adopting the Canadian Medicare model and not the Dutch insured one.

The Canadian system recognises that GP’s are self-employed professionals. Each province’s Medicare system pays them per visit and treatment, not by single per capital fee per annum. GP’s mainly work in clinic-based teams that manage patients based on need and by appointment, but the system is efficient because it shares costs and bills a single paymaster. It by-passes insurers.

Private health insurance in Canada, mainly an occupational benefit that mainly purchased a semi-private or private room in a Medicare hospital but never allowed anyone to jump queues in acute hospitals, now covers elective treatments in wholly private specialist clinics, a consequence of growing waiting lists for elective treatment.

Under the draft UHI plan here, we are told there will be no queue jumping at all since all hospitals (public and private) will be required to treat every patient based on need.  The rich man with the more serious hernia or wonky hip (who could get treatment via insurance in Canada) will in Ireland be treated before the poor man, with the less worse-off hernia.

That’s a funny kind of equal access.

I once said I’d sell my car before I got rid of my health insurance. I may have to yet.

Universal health insurance, plus the risk rated (not community rated) supplementary insurance to cover all the benefits I currently receive from my private insurance is going to cost a lot more money.

Get used to it.  Start saving.  Equality doesn’t come cheap.



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