A single tier health system will be established, representing a fundamental change from the current public / private division.
Every person will be insured for the same package or “basket” of healthcare services. People will purchase a universal health insurance policy from a competing insurer of their choice. This will cover the set basket of services, which will be determined after a consultation process. Insurers will not be able to charge a different premium based on a person’s risk profile. Also insurers will not be able to market a policy selling faster access to services covered by the standard policy.
The White Paper plans to give every person a universal entitlement to core primary care services from GPs, practice nurses and public health / community nurses. It is proposed that the standard basket will include acute in-patient, out-patient and day-case care, as well as cancer care. Rehabilitative care would be included subject to an overall time limit (eg one year). Every person would be covered for mental health services provided by community health teams, out-patient clinics and acute in-patient services for a set time period. Long term social and continuing care services would not be covered and will be funded by general taxation. Convalescent and step-down services would be included in the standard package.
It is proposed that the State will provide subsidies for the insurance premium for qualifying individuals and would pay the premium for the lowest income groups. The exact cost of the standard basket of services is not known, as it has yet to be comprehensively defined. General taxation will be used to fund the subsidies and also services such as ambulance services. It is stated that State spending under the new system should not exceed spending under the current system.
It is planned that health reform legislation will abolish the HSE. In terms of timing, it is envisaged that Universal Health Insurance will be fully implemented by 2019.