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What is FairCare? What is FairCare? Our vision is to have a world-class health service, ranked among the top three in Europe, where: Waiting lists for hospital treatment have been abolished; This is not an unaffordable goal. Getting better value for money from our health system is even more important during a recession. Fine Gael has studied the health systems of other countries, such as the Netherlands, that spend similar amount on health as Ireland. They have already achieved these outcomes by radically reforming their health services to deliver greater fairness and efficiency. Under Fine Gael’s FairCare strategy, Ireland can do the same. The quadrupling of the Irish health budget since 1997 has proved one thing – a poorly organised and managed health system cannot be fixed with money alone. People still cannot access treatment when they need it most:
Rather than fixing the health service and controlling wasteful spending, the current Government it is more interested in saving money through the withdrawal of patient services, such as lifesaving cervical cancer vaccination. This is not good enough. Fine Gael’s FairCare reforms to the financing, delivery, and structures of healthcare will increase safety, improve quality and introduce efficiency in the delivery of health services, while ensuring equal and timely access for everyone. Phase 1 will see a much more rigorous and effective approach to the management of waiting lists & waiting times through the establishment of a Service Delivery Unit, with real political backing, like that established in Northern Ireland. This process will see that existing capacity is used properly. Phase 2 will introduce “Money Follows the Patient” (MFTP). Under the current system of fixed budgets, public patients are treated as “costs” to the health service. By contrast, under MFTP, hospitals are paid for how many patients they treat i.e. money follows the patient. Therefore, patients are no longer seen as “costs” to the health service, but are seen as sources of “income”. International evidence shows that Money Follows the Patient increases healthcare efficiency by at least 10%, helping to further cut waiting lists. Phase 3 will introduce Universal Health Insurance (UHI).
Other services may be added over time as national circumstances allow. In this way, medical card holders will retain free access to health care and will benefit from FairCare through the elimination of waiting lists for hospital services. The insurance costs of medical card holder will be covered by a new health insurance voucher, and they will now have equal access to all hospital services alongside all other residents. Customers will remain free to purchase “top-up” insurance from insurance providers for supplementary services not provided by the basic package. Yes, the system will require that patients are allowed to continue to choose their own GPs. Depending on the details of the insurance policy, patients will also be allowed to choose their own hospitals and consultants also. No, under FairCare, insurance companies will not be allowed to refuse cover to anybody entitled to reside here. They will also be subject to Community Rating, which means that no individual insurance company can charge different amounts to different individuals for the same basic insurance package. The principle of Community Rating will be underpinned by a sophisticated system of Risk Equalisation, which means that insurance companies will get extra funds from Government for taking on higher-risk, higher-cost customers. Ongoing improvements to the risk equalisation formula in the Netherlands have made it unprofitable for insurance companies to invest in risk selection techniques (trying to attract less costly customers). Indeed, good risk equalisation has even made it attractive for insurance companies to attract customers with chronic conditions, where there is greater opportunity to improve the cost efficiency and quality of treatment. The balance in funding for healthcare between insurance premiums paid by customers and taxation (to pay for vouchers and subsidies for children and lower-income families and for payments into the Risk Equalisation Fund) will be determined by Government. It will initially be set in such a way that insurance premiums will not exceed current levels in real terms (adjusted for changes in prices and wages). Between taxes, private health insurance and “out-of-pocket” private payments for GPs, medicines etc., Irish residents will this year spend an enormous €20 billion on our health services, putting us among the biggest spenders on healthcare (on a per capita basis) in the world. Unfortunately, much of this money is being wasted on an inefficient bureaucratic system that does not work. As the recession deepens and Government borrowing escalates, it is becoming increasingly clear that we cannot afford to continue with the present wasteful system. Fine Gael’s “FairCare” strategy will mean some additional costs for the Irish healthcare system – such as the introduction of a package of free GP care for all and an improved patient safety and quality system – but it will also lead to massive reductions in waste and bureaucracy and better value for money, as well as draw in additional investment into the Irish health care system.
Additional Revenues / Lower Costs
The reforms set out in Phase 1 maximise existing capacity. We must cut out much of the wasteful spending and cut hospital waiting lists before we move to universal health insurance. Nothern Ireland has showed how this can be done without injecting significant additional resources. The introduction of MFTP in Phase 2 will have initial start-up IT costs; however, international comparisons show that efficiency improvements of at least 10% can be expected through the introduction of this system as hospitals respond to the end of fixed budgeting and the new incentives to cut costs and treat more patients. Evidence from other countries shows that UHI system can improve the cost efficiency of health care through:
The Government’s policy of centralising health financing and delivery under the HSE has been a failure for Ireland, and under FairCare, the HSE organisation will be significantly slimmed down and given greater focus. It will no longer have responsibility for “cure services” (hospital care, GP services, medicines etc.). Under FairCare, decision making and administration will be decentralised to insurance companies and healthcare providers, such as individual GP practices and local hospitals. Health policy development will be the responsibility for the Department of Health and Children, restoring political accountability of the Minister for Health to the Oireachtas for health policy and implementation. The HSE will retain responsibility for “care services” long term care and other important areas including child protection and public health. FairCare will mean a significant reduction in the need HSE administrative and managerial staff. Through negotiation with staff and their trade unions, this will be facilitated through a combination of reallocation to other parts of the public service, transfers to the health insurance organisation that will take over the administration of financing hospital and primary care and redundancies. HSE staff working in long-term care and social services will remain with the HSE. HSE staff currently working in hospitals will also continue to do so, but the responsibility for negotiating staffing levels and mixes and terms and conditions of employment in hospitals will ultimately transfer from the HSE to hospitals themselves, as occurs in other European countries with decentralised, insurance-financed systems. All staff will continue to be free to pursue collective bargaining with the employers through their trade unions. Universal health insurance operates in most EU countries and places like Canada. It is a tried and tested model that works. Fine Gael has looked closely at the model of social insurance that operates in the Netherland which was recently rated the number 1 health service in Europe for Quality and number 2 for Value for Money (Euro Health Consumer Index). By contrast, Ireland was ranked number 15 for Quality and number 24 for Value for Money. Go back to top. HSE hospitals will continue to be owned by the State, but will be governed and managed by Local Hospital Trusts so that they are managed to best respond to meet the needs of the local community and their patients. So instead of the HSE determining the future of a local hospital, its future will now be in local hands. Voluntary Hospitals will continue to be run by their Boards. Private for-profit hospitals will also continue to operate as is. Go back to top. The inspiration for Fine Gael’s FairCare strategy has come from the Netherlands and other European countries with universal health insurance systems, which guarantee access to health care for all residents irrespective of means. This is in sharp contrast to the U.S. model, where a significant proportion of the population cannot afford health insurance. Under FairCare there will continue to be a mix of state-owned, private not-for-profit (like the current voluntary hospitals) and for-profit hospitals operating in Ireland. Hospitals currently owned by the State and run by the HSE will remain in State ownership. While governance and management will be decentralised to Local Hospital Trust, state-owned hospitals will not be privatised under Fine Gael. Go back to top. Under, Fine Gael’s FairCare strategy, the position in the Irish health care system of state-owned and independent, not-for-profit hospitals (the “voluntary hospitals”) will be strengthened. This will be done by abandoning the current Government policy of hospital co-location, as well as by giving not-for-profit hospitals a “head start” in a decentralised hospital system by not charging them for the capital cost of the buildings and equipment paid for by the tax-payer. The State will also continue to directly subsidise the cost of A&E, teaching, research and certain tertiary specialities in hospitals, and will retain responsibility for driving the development of these services. With stable and predictable sources of revenues from insurance companies, and with most not-for-profit hospitals debt-free on establishment, there will be significant scope for not-for-profit hospitals to finance new investments in capacity and new technologies through borrowing. Irish hospitals have also shown a capacity to raise other funds for equipment and other capital developments and it is expected that this will continue under the new governance arrangements. Go back to top. Fine Gael has consistently opposed the policy of private hospital co-location because it served to reinforce the current 2-tier health system. While a Fine Gael Government will, of course, respect any hospital co-location contracts already signed by the State prior to it assuming power, we will not enter into any further co-location contracts. Co-located private hospitals will operate like other hospitals under the system of Universal Health Insurance. Go back to top. As in other countries with a system of Universal Health Insurance, such as the Netherlands, the Government will continue to determine the location of A&E facilities across the country. Fine Gael believes that the current Government’s plan to reorganise A&E services puts patients’ lives at risk. Their plan has seen A&E departments closed without:
Health services cannot be reorganised on a piecemeal basis. Fine Gael in Government would not see the withdrawal or critical A&E services until the proper safeguards and supports for local communities are put in place so that peoples’ lives are not put at risk. Go back to top. There is no obvious benefit for providing non-insurable, long-term care services through an insurance system. The State will retain responsibility for the procurement and provision of long-term “Care services”, through the HSE.
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