A few thoughts on Fine Gael’s new health policy which you can get here and read their summary below. Some interesting stuff. My thoughts in red.
” Fine Gael’s FairCare proposals, by contrast, represent the most fundamental reform of the health system since the formation of the State. We will abolish long-term waits on trolleys in A&E, slash waiting lists in hospitals, and eliminate the unfair and inefficient public/private divide by introducing Universal Health Insurance (UHI). We will also reform the Primary Care system to ensure that more patients are treated safely outside hospitals by their GPs. (Ok, so we start with a set of reasonable principles. Fair enough.)
Primary Care Reform is Crucial
Since it was first announced in 2001, the Government has consistently failed to meet the key targets in its Primary Care strategy. (God love them, but FG just have to get the boot into FF. They can’t help it. A bit like a monkey eating lice from another monkey’s hair. It’s genetic)
Fine Gael will give Primary Care the priority it deserves. By the end of our first term in Government, we will have a comprehensive network of new Primary Care centres to serve our communities. The community they serve will determine the size and scale of the centre. Depending on population coverage, their services will include X-Ray, Ultrasound, Endoscopy, Physio, CT and MRI scanning, etc. The centres will also include rooms for visiting specialists and will accommodate a robust community mental health service. (And the funds for these will be found where exactly?)
Patient flows to hospital will be further reduced by the availability of a National Body Test (NBT) to pick up illness early, and by the existence of chronic illness programmes for diseases such as high blood pressure, asthma, etc. to prevent the complications that land people in hospital. (This is a very good idea, but it will be paid for how?)
We believe that the capital costs of this programme can largely be borne by the private sector, if appropriate long-term contracts are put in place. If additional incentives are required, such as Accelerated Capital Depreciation, this requirement will be addressed. (Hmm. Private sector, eh? Will some be built on public land to make it attractive to the private sector? Isn’t there a phrase for this?….oh yes, co-location. The policy FG has opposed since Mary Harney introduced it. Oh well. Maybe they’ll call it something else, like lo-cocation?)
A 3-Phase Programme
Reforming the Irish health system will not be easy. The last thing Ireland needs is another ill-conceived experiment like the formation of the Health Service Executive (HSE). (Because the health boards really worked so well!) In addition, any reform must be undertaken within Fine Gael’s overall budgetary framework. We have, therefore, divided our FairCare programme into three distinct, but over-lapping phases that will allow us to gradually introduce reforms in a way that is both carefully planned and affordable. (I liked this. Sounds reasonable, to give it its due.)
Phase 1: Maximise what we have
(Implemented from Year 1)
In the first phase of FairCare, we will change the way hospitals work and, as indicated above, will also significantly strengthen Ireland’s Primary Care system.
As part of our hospital reform programme, we will make the Minister of Health directly responsible for hitting key targets. Progress will be measured daily by real time information systems (This won’t be cheap. remember PULSE and PPARS?) , and a Special Delivery Unit will be established to assist the Minister. A similar unit was successfully used in Northern Ireland to help slash waiting lists, e.g., inpatient waiting lists for those waiting more than 3 months fell by 80% from 2004 to 2008. Crucially, this was done without significantly increasing spending. (But in a political system where politicians take sides as opposed to sitting on the fence and calling for someone else to hold “a full scale review”.)
Fine Gael recognises that significant bed capacity in hospitals could also be freed-up if patients facing delayed discharge or requiring rehabilitation could be treated in the Community. We will publish specific proposals on this issue over the next few months to address the current deficits in long-term care and rehabilitation. (Fair enough as long as they are costed and fund mandated, i.e. whose pocket they’re coming out of.)
Fine Gael will also ensure that resources arising from the sale of psychiatric institutions and lands, will be ring-fenced to mental health. Psychiatric illness must be treated like any other illness, and resourced accordingly. (A fair suggestion, but does it not mean that current services will be funded out of the disposal of capital assets, which means that the following year there’ll be no revenue available to continue the services?)
Phase 2: Introduce “Money follows the patient” (Implemented in Year 5)
Under the current system of fixed budgets, each additional patient is effectively a “cost” to the health service. This system provides no incentives for efficiency or productivity. Under MFTP, health providers will be paid for how many patients they treat. Patients will be a source of “income” rather than a “cost”, just as they are in private hospitals today.
MFTP will mean that decision-making is increasingly devolved to the hospitals themselves. Once MFTP is introduced, the National Treatment Purchase Fund will be closed, saving around €100 mn a year. Long term, we expect MFTP to increase efficiency by as much as 10%. (This is very similar to what the Tories implemented in the UK, and might work as long as the money keeps flowing. But what happens to the underperforming hospitals? Will we really let them wither and close, or bale them out as well under pressure from backbenchers, thus actually spending MORE money than we spent before?)
Phase 3: “Universal Health Insurance” (Implemented in Year 5)
Once the first and second phases of FairCare have been successfully implemented, Fine Gael will introduce Universal Health Insurance (UHI), a system that is widely used in Europe and in Canada. UHI will only be introduced once waiting lists have been significantly reduced in Phases 1 and 2. In the interim, the current system of voluntary insurance in Ireland will remain in place.
Within its first 30 days in office, a Fine Gael Government will establish a UHI COMMISSION, which will include representatives from all of the major stakeholders in the health service. Its primary task will be to build a consensus (A consensus? From the people who have the health service the way it is today. Wasn’t that what we paid benchmarking for?) around the practical measures that need to be taken to prepare the health system for UHI. One of the keys to success for any insurance system is strong regulation. The Regulator will be answerable to the Minister and the Oireachtas.
Fine Gael proposes to introduce the Dutch model of UHI in Ireland, with mandatory health insurance for everyone, to be chosen from a selection of providers. The Netherlands spends only slightly more than us on health on a per capita basis, but is ranked number 1 in Europe for quality and Number 2 for value for money (Source: European Health Consumer Index 2008).
The Dutch system of UHI has strict community rating and an obligation to cover, which means that insurance companies will not be able to discriminate against anybody on the basis of age, sex, medical history, etc. This will be underpinned by a system of Risk Equalisation, which will compensate insurers for covering higher risk, higher cost patients. The insurance model will also address mental health. (Just wait until you try to get 18 year olds to pay for compulsory health insurance. The Stealth Health Tax?)
Under UHI, everyone will receive a package of free GP care, paid for by some rebalancing of the tax system (Whoa there Bessy! ”Rebalancing?” That sure sounds like a good ole fashioned tax increase right there!), and significant savings (Ah, the magic that is “significant savings”, the magic bullet of every manifesto, up there with “efficiencies” and “cutting waste”) as the insurance companies bring down costs. There will, in addition, be significant savings in administration. At the moment, Ireland has two administrative systems for health – one public (the HSE) and one private (the insurance companies) – resulting in enormous duplication and waste. Over time, these two systems will become one, run by the insurance companies. As a result, the number of administrative staff employed in the HSE will likely fall by at least 5,000, as its role becomes more focused on long term care, public health, etc. (Wow. That’s gutsy. 5000 job cuts. If Labour let them.)
UHI will require the insurance industry in Ireland to play a much greater role in negotiating contracts with hospitals and other providers, and in driving innovation, than has been the case to date. Fine Gael will not introduce UHI until it is certain that the insurance companies are capable of taking on the expanded role required of them. A Fine Gael Government will encourage insurance companies from other European countries, who have experience of implementing social insurance models, to enter the Irish market.”
There’s some good stuff here, it has to be said. But it relies an awful lot of FG facing down its own backbenchers, the vested interests with the health service and the Labour party. Maybe I’m being unfair, but backbone has never been an FG thing.