Sláintecare

Sláintecare is a proposed reform of the healthcare system of Ireland.

Under the existing health service system large out-of-pocket payments are required; the Republic of Ireland is the only state within the EU which does not provide universal healthcare, according to WHO criteria.[1] The newly elected Irish government committed itself in March 2011 to reform the two-tier structure of national health service in response to public discontent with austerity measures from 2008 onwards.[2] Since public funding of health provision was reduced between 2009 and 2013 to meet payment obligations arising from the state's budget deficit, citizens faced higher medical charges and extended waiting lists.[3]

In reaction to this development, the coalition government of Fine Gael and the Labour Party declared to introduce “a universal single-tiered health service, which guarantees access based on need, not income… through Universal Health Insurance.”[4] The published government plan, outlined in the 2014 document “The Path to UHC – The White Paper”, foresaw introducing compulsory private health insurance based on managed competition between insurance companies to abolish the distinction between public and private patient status.[3] Key features of the policy entailed mandatory health insurance for every citizen under free choice of insurer as well as entitlement to the same package of care, covering primary and acute hospital services.[5] Further, patients should be charged in turn insurance premium irrespective of age or risk profile and additionally have the right to change their insurance membership on an annual basis.[6] Those citizens who are unable to afford the amount of premium would have qualified for subsidies to cover the required premium payments by a National Insurance fund.[7]

The implementation of the proposed model of universal health insurance was supposed to be conducted by 2019.[2] However, after a public consultation procedure regarding the reform initiatives the plan of universal health insurance was abandoned by the Irish administration in November 2015 due to projections that the envisaged system would be too costly and would still require the highest share of funds by general taxation.[8] According to the state department of health, the implied costs of universal health insurance would have led to approximately 11% higher expenditures than the existing system.[9] After the Irish parliamentary election of 2016, Fine Gael formed a minority government supported by independent parliamentarians. Social Democrat TD Róisín Shortall founded in June 2016 an all-party “Committee on the Future of Healthcare” following an initiative by the health department with the aim to identify an appropriate approach for establishing universal healthcare in Ireland.[10] The committee was supported by an academic team from Trinity College Dublin to analyse submissions made within 30 public hearings in the course of the public consultation process.[11] In May 2017 the committee published its final report entitled “Committee on the Future of Health, Sláintecare Report[12]”, which specified universal healthcare based on the following definition:

A universal healthcare system will provide population, promotive, preventative, primary, curative, rehabilitative and palliative health and social care services to the entire population of Ireland, ensuring timely access to quality, effective, integrated services on the basis of clinical need.

— Committee on the Future of Health, Sláintecare Report[13]

The document entails a proposed ten-year plan for reforming the Irish health system towards universal healthcare.[13] It consists of five sections, covering Population health profile, Entitlements and Access to Healthcare, Integrated care, Funding and Implementation.[13] The report foresees the provision of health cards called Carta Sláinte to every citizen, granting access to primary care free of charges at specified local entities preferably outside of hospitals.[11] This system is planned to be funded by taxation, requiring an increase of public health spending and further infrastructure investment of approximately 3 billion Euros.[13] The submitted plan was debated twice in the parliament in 2017 and the Irish government decided to found an official implementation office to appoint a head of the organisation as well as to develop a drafted implementation plan by December 2017.[11]

References
  1. Tamas, Evetovits,; Policies, European Observatory on Health Systems and; Europe, WHO Regional Office for (2012-11-16). "Health system responses to financial pressures in Ireland: policy options in an international context"
  2. Burke, Sara Ann; Normand, Charles; Barry, Sarah; Thomas, Steve (March 2016). "From universal health insurance to universal healthcare? The shifting health policy landscape in Ireland since the economic crisis". Health Policy. 120 (3): 235–240. doi:10.1016/j.healthpol.2015.12.001. ISSN 0168-8510.
  3. Byers, Vivienne (March 2017). "Health Care for All in Ireland? The Consequences of Politics for Health Policy". World Medical & Health Policy. 9 (1): 138–151. doi:10.1002/wmh3.217. ISSN 1948-4682.
  4. "Universal Health Insurance".
  5. "White Paper on Universal Health Insurance" (PDF).
  6. "White Paper on Universal Health Insurance" (PDF).
  7. "White Paper on Universal Health Insurance" (PDF).
  8. Wren, Maev-Ann; Connolly, Sheelah (2017-12-26). "A European late starter: lessons from the history of reform in Irish health care". Health Economics, Policy and Law: 1–19. doi:10.1017/s1744133117000275. ISSN 1744-1331. PMID 29277162.
  9. Clements, Richard (October 2016). "3. Prime Minister and Cabinet". Law Trove. 1. doi:10.1093/he/9780198745259.003.0003.
  10. "Committee on the Future of Healthcare".
  11. Burke, Sara; Barry, Sarah; Siersbaek, Rikke; Johnston, Bridget; Ní Fhallúin, Maebh; Thomas, Steve (May 2018). "Sláintecare – A ten-year plan to achieve universal healthcare in Ireland". Health Policy. 122 (12): 1278–1282. doi:10.1016/j.healthpol.2018.05.006. ISSN 0168-8510. PMID 29843901.
  12. https://www.gov.ie/en/publication/0d2d60-slaintecare-publications/
  13. "Committee on the Future of Healthcare".
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