Reilly rises but FairCare lacks detail

Fine Gael's plans for reforming the healthcare system seem well-intentioned, but are unrealistic. By Sara Burke.

James Reilly has been rewarded for his staunch defence of Enda Kenny in the Fine Gael heave by his ascension to Deputy Leader of the party and reappointment to the front bench in health. So what does Fine Gael’s James Reilly stand for and what would Fine Gael’s health policy mean to the Irish people?

It is not always that easy to tell what Reilly actually stands for, although it is much more obvious what he’s against - much of current health policy. He is very critical of the Minister for Health and Children Mary Harney and her policies, and is often dogged in his criticisms of the HSE - the failures, the scandals, the misdiagnoses, long waits on trolleys and for outpatient appointments and the failure to invest in primary care.

Reilly is a GP with surgeries in Lusk and Donabate and according to his website he is ‘involved in the development of a new town centre in Lusk to provide medical facilities’. He is a believer in the entrepreneurial aspect of primary care and in Ireland’s complicated public and private mix of healthcare.

Should Fine Gael become the majority party in the next government, Reilly is intent on becoming the next Minister for Health. His ambition is apparent in his career trajectory. Just three years ago he was elected for Dublin North when he successfully won Fianna Fáil TD Jim Glennon’s seat. Once elected to Dáil Eireann, he was instantly made health spokesperson.

Reilly was president of the Irish Medical Organisation (IMO) before he was elected a TD, and he was head of the GP section of the IMO in 2001/2.

He has also been instrumental in developing Fine Gael’s FairCare policy.

Influenced by Reilly, Enda Kenny set up a Health Commission chaired by Alan Dukes in 2008 that recommended Faircare, a policy that commits to getting rid of the two-tier health system by introducing a mandatory health insurance system.

According to the Dukes-chaired Commission's proposals, people who currently pay private health insurance would pay the same. Those with medical cards would be paid for by government. And those without either would have to pay a sum (estimated by Reilly at €200 a year) for which they would be entitled to free GP visits, drugs and hospital care.

FairCare was launched in April 2009. Since then Reilly, Enda Kenny and Frances Fitzgerald have been busy touring the country selling it to the Fine Gael supporters. FairCare commits Fine Gael to a form of universal health insurance modelled on the Dutch system, with three stages to be introduced over a five year period. These include:

• ‘Maximising what we have’ – beefing up primary care and ‘slashing hospital waiting lists’
• ‘Money follows the patient’ and the continued development of primary care
• Free GP care and universal health insurance

So is there anything new in FairCare?  The Labour party have been recommending social health insurance since 2001 but their model differs to the Fine Gael one as they envisage a single not-for-profit insurer, whereas the Fine Gael proposal is based on profitable private insurers competing for business.

Many aspects of FairCare are part of current government policy on healthcare, including commitments to increasing efficiencies in the system, reducing waiting times, and building up primary care. Proposals based on the concept of ‘money follows the patient’ are inevitable no matter who is in charge and are already being built into the health system, albeit slowly.

However FairCare differs crucially from current government policy in that services would be provided free at the point of delivery to all citizens and access would be based on need, not ability to pay. A year ago, when they published the policy, Fine Gael said more detail would follow. But unfortunately, most of the detail remains elusive.

No specific costings have been referred to, except a constant reiteration that no one will have to pay more. To justify the no additional cost element, the party have suggested reducing HSE staff by 5,000 and encouraging increased competition among insurers to drive down costs, among other things.

However the HSE is currently saving hundreds of millions of euros by increasing efficiency. Fine Gael have suggested reducing 5,000 HSE staff through redundancies and redeployment to the insurers but considering that the HSE is currently redeploying and pushing redundancies it seems unlikely that private, profitable insurers would want to hire up to 5,000 HSE staff.

According to the FairCare policy, competition would drive down costs. Yet in Holland, where their model is based, the reform took about 20 years to get to the start line and has been in place since just 2006. While there were reduced costs due to competing private providers in first two years, the costs have gone back up by 10% in 2007 and 2008. The Dutch government has also had to hire about 500 extra staff to regulate the insurance industry, costing more money.

For such huge change people need to believe it will happen. For it to happen people will need to see real gains quickly. Fine Gael say five years is the timeframe but their own commission recommended a ten year timeframe. Faircare recommends setting up “a Universal Health Insurance (UHI) commission in its [the party's] first 30 days in Government” where they will work the detail with “all the major stakeholders in the health service to agree an implementation plan so that the proven Dutch system of UHI is best adapted to Irish circumstances.”

The international experience is that it would take more than 30 days to get all that done. It would depend on who Fine Gael were in government with, the size of the parties and the distribution of power. A Resource Allocation Working Group set up by Mary Harney is due to report and that report will influence how the Department of Health proceeds in this area in the years and decades ahead. Unofficially the Resource Allocation Working Group is due to report this week and the indications are that it will not recommend universal/social health insurance.