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Market not route to universal coverage, Summit hears

By Mindo - 01st Mar 2018

<p class=”p1″>Mr Robert Yates, Project Director of the Universal Health Coverage Policy Forum at <span class=”s1″>the Royal Institute of International Affairs in London, told the Summit that international experience proves that “a market driven sys</span>tem where people are privately buying and <span class=”s1″>selling health services like you would do with </span>restaurant meals or subscription for a mo<span class=”s1″>bile phone or something like that, will never ever take you to universal health coverage”.</span>

<p class=”p1″>“You only have to look at the mess of the <span class=”s1″>US health system to recognise that that is the case – 18 per cent of its GDP on a health sys</span>tem where 28 million Americans don’t get <span class=”s1″>the services they need,” said Mr Yates.</span>

<p class=”p1″><span class=”s1″>“So because the free market will never ever do these cross-subsidies at the level that is required you need the State to force wealthy </span>and healthy people to cross subsidise the sick and the poor. That very much means the State very much governs the health finance system and is involved in all the ma<span class=”s1″>or functions of that financing system in how </span>you raise the money, how you put it in the <span class=”s1″>big pot. Then how you allocate it to purchasing services.”</span>

<p class=”p1″>In his presentation Mr Yates noted that the issue of moving towards universal health cov<span class=”s1″>erage is a very political process. He said that the future moves towards <em>Sláintecare </em>in this coun</span><span class=”s1″>try would also involve serious politics. </span>“Universal health coverage is very much <span class=”s1″>about replacing private voluntary financing </span>with public compulsory financing,” said Mr <span class=”s1″>Yates. </span>“I’m not saying anything about the provision of services here. Everything does not have to be run by the State, there are systems, like France and Japan, where almost all the services are privately run, but the fi<span class=”s1″>nancing is not exclusively, but predominately, public.</span>

<p class=”p1″>“But moving towards that system is inherently political. Because there are lots of vest<span class=”s1″>ed interest groups that don’t want to do that.”</span>

<p class=”p1″>Also speaking at the conference, CEO of the University of Limerick Hospitals Group <span class=”s1″>Ms Colette Cowan said that the impact of the <em>Sláintecare Report </em>had been discussed among the leadership of the HSE Hospital Groups.</span>

<p class=”p1″>“We have talked about budgets at a Group <span class=”s1″>CEO level, about Sláintecare and the reconfiguration of the Hospitals Groups,” said Ms Cowan.</span>

<p class=”p1″><span class=”s1″>“In my view, in the future if it all works out </span>well for Sláintecare is that model four hospitals will just be critical care. Patients will <span class=”s1″>come for really acute care and the system will shift into the community. How we shift that </span>burden of payment will be an open debate that we have to have. We already struggle <span class=”s1″>with [finance], because each of the hospitals in the mid-west are graded differently, there are different costs associated with them, but </span>doctors move between the sites. That is our first challenge to try and work that out and <span class=”s1″>make it a single system.”</span>

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