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Insurance-based healthcare hugely problematic – Ó Caoláin

15 March, 2011 - by Caoimhghín Ó Caoláin TD

Sinn Féin Health & Children spokesperson Caoimhghín Ó Caoláin TD, speaking in the Dáil debate on the Programme for Government, stated that the insurance-based model of healthcare in the Fine Gael-Labour Programme is “highly problematic” and is in deep trouble in the Netherlands.

He said:

“The policy changes proposed in the Health section of this Programme are very far-reaching. Unfortunately, the Programme raises as many questions as it answers on the approach of the new Government to healthcare.

“The Programme appears to be a compromise between the insurance-based models put forward by Fine Gael and Labour. The commitment in the Programme is to developing a universal, single-tier health service which guarantees access to medical care based on need, not income.

“That is a fundamental principle, one that Sinn Féin has long advocated. It is our strong view that such a health service can be delivered equitably and efficiently only on the basis of public provision, funded from fair taxation and with an end to the State subsidisation of the private healthcare industry.

“The insurance-based model which is the centre-piece of healthcare in this Programme for Government is highly problematic. Experience from other countries, including the Netherlands on which Fine Gael bases its approach, points to the danger of insurance companies being given an undue role in determining the level of care received by health service users.

“In the Netherlands today the insurance-based system has run into huge problems with half a million people uninsured or defaulting on health insurance payments. Private health insurance companies are finding ways to circumvent the ban on ‘risk selection’. The Universal Health Insurance basic package in the Netherlands is €1194 per person. Employers deduct a further 6.9% of income. The average cost of health insurance per household is estimated at around €5000.

“41% of people surveyed in the Netherlands say that the quality of the health system has worsened since the introduction of Universal Health Insurance in 2006, while only 8% indicated that it had improved.

“The Government may argue that this Programme is a compromise and that it does not fully adopt the Dutch system. But the problems with insurance-based systems have been well identified and this Programme does nothing to allay those concerns. On the contrary, it is quite alarming that the healthcare section of this Programme contains no costings, apart from those for the limited initial extension of free GP care.

“When Fine Gael initially published its Fair Care plan it promised to provide further details, including costings, but this has not been done. When are we going to see those detailed figures and projections? It certainly cannot be argued that Fine Gael lacked the resources to provide the necessary expertise to elaborate on its policy given the enormous sums of money that the party has obviously spent on the General Election.

“Let it be said that many of the aspirations and proposals in the Health section of the Programme are commendable. I include the extension of free GP care to all, within this Government’s term of office. That is a very big commitment. We are told that the extension of free GP care to certain categories of patients in the first two years will cost €32 million. But what happens after that? Presumably the promised extension to all within the lifetime of this Government will be dependent on the negotiation of a new GP contract.

“We are told that all of this will be transitional, until the introduction of Universal Health Insurance by 2016.

“But what happens in the meantime? Will the Fianna Fáil/Green Party health cuts be reversed? Will the recruitment embargo in the health services be lifted? Will the payment for working student nurses be fully restored?

“I welcome the commitment to compensate the women excluded from the Lourdes Hospital Redress Scheme. But what about the issue of symphysiotomy? Will there be an inquiry?”


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