Today, Thursday 16 June, the ESRI published a paper examining the rationale and the requirements for achieving universal healthcare, which the World Health Organisation (WHO) advocates as the most effective means of improving global health. Using a framework developed by the WHO to monitor the achievement of a universal system, the paper found that the model of Universal Health Insurance (UHI) proposed by the 2011-2016 Government could have increased costs without achieving universality and equitable access. The paper recommends that future policy should aim to move towards universality while building in a cost-effective way from the existing Irish system.

The objectives of universal healthcare
Universal healthcare systems aim to remove financial barriers to accessing care by creating a pre-paid pooled fund or funds, whether by taxation, social insurance or, less commonly, with a central role for private health insurers. The financing mechanism is secondary to the objective of universality.  The extent of universal coverage depends on the proportion of necessary services that are financed from the fund; the breadth of population coverage; and the extent of out-of-pocket payment to access necessary healthcare.

Universality and the 2014 model of UHI
While full population coverage was envisaged in the UHI model proposed in the 2014 White Paper, there was uncertainty about the services and costs to be covered by the insured standard package and about the level of out-of-pocket charges, thereby undermining the universality of the proposed model.

Potential routes to universal healthcare
While developing a comprehensive roadmap to universality was beyond the scope of this paper, it discusses some potential routes to advance towards universality. Within primary care, universality could be advanced by extending the present tax-financed system.  Within hospital care, universality could be advanced by either a new public purchaser of hospital care or by introducing compulsory private insurance for elective hospital care. Such a system should be designed to ensure payment according to ability to pay and Government control of insurers’ margins and other costs.
Commenting on the paper, Dr Maev-Ann Wren, an author of the paper stated, “Any proposed reform should be subject to rigorous cost-benefit analysis, which would assess the costs of the system change relative to the potential gains in health outcomes, equity and system efficiency; and relative to alternative pathways to universality.”