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Market not route to universal coverage, Summit hears

Mr Robert Yates, Project Director of the Universal Health Coverage Policy Forum at the Royal Institute of International Affairs in London, told the Summit that international experience proves that “a market driven system where people are privately buying and selling health services like you would do with restaurant meals or subscription for a mobile phone or something like that, will never ever take you to universal health coverage”.

“You only have to look at the mess of the US health system to recognise that that is the case – 18 per cent of its GDP on a health system where 28 million Americans don’t get the services they need,” said Mr Yates.

“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 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 maor functions of that financing system in how you raise the money, how you put it in the big pot. Then how you allocate it to purchasing services.”

In his presentation Mr Yates noted that the issue of moving towards universal health coverage is a very political process. He said that the future moves towards Sláintecare in this country would also involve serious politics. “Universal health coverage is very much about replacing private voluntary financing with public compulsory financing,” said Mr Yates. “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 financing is not exclusively, but predominately, public.

“But moving towards that system is inherently political. Because there are lots of vested interest groups that don’t want to do that.”

Also speaking at the conference, CEO of the University of Limerick Hospitals Group Ms Colette Cowan said that the impact of the Sláintecare Report had been discussed among the leadership of the HSE Hospital Groups.

“We have talked about budgets at a Group CEO level, about Sláintecare and the reconfiguration of the Hospitals Groups,” said Ms Cowan.

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

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