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NHS crisis: Ireland shows why paying for GPs and A&E is a bad idea [1]
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Date: 2023-04
According to politicians, journalists and even exasperated frontline workers, the NHS is trembling on its last legs. Soul-searching, unsentimental reform and new thinking are, we are being told, required to resuscitate the health service and prevent its total collapse, just as nurses go on strike for livable working conditions and thousands die from emergency department delays alone. Being pumped out at a steady clip are an assortment of half-baked solutions for this crisis, one that was created in large part by the same austerian Tories who claim to have all of the answers.
Last month, Sajid Javid, the former secretary of state for health and social care, sang the praises of fees for GP and hospital visits. “Take Ireland,” he wrote of the country’s two-tier system, “where some people are entitled to free healthcare through the public system, based on household income.” He took stock of Germany, home to a typical European social insurance model, as well as the £20 GP fees in Norway and Sweden. In particularly effusive terms, he hailed the Irish Health Service Executive (HSE), giving the example of what he ludicrously calls a “nominal” €75 fee, payable by most in Ireland for a visit to an injury unit.
To combat NHS dysfunction, an NHS.2 should, in Javid’s judgement, involve a “contributory principle to complement public financing”. Such a system, he claims, gives one control over demand, redirecting it to “more efficient methods of supply”.
Means-tested fees in Ireland, however, have created a scenario in which low- and middle-income earners were found to be five times more likely to forgo a primary care appointment than their wealthier counterparts. But demand for medical care has not simply evaporated into thin air – many people in Ireland neglect and de-prioritise their health, or take out costly private insurance to jump the queue for certain treatments.
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Just under half (47.5%) of the Irish population have private health insurance, one of the highest levels of take-up in Europe, and premiums – which are soaring across the board – cost individual adult policyholders an average of €1,412, according to one price comparison site. As one might expect, the privately insured receive preferential treatment and superior services to less affluent sections of Irish society, most of whom endure extreme waiting lists and much-hated out-of-pocket expenses.
Just before Christmas, The Times analysed the Irish system generally and GP fees specifically, finding widespread disapproval of the two-tier hybrid among patients and academics. Since the Irish model is occasionally singled out for emulation by English observers, it is worth discussing why.
Far from being an answer to the multi-pronged crises afflicting the NHS, Ireland’s health service is a crumbling deathtrap with a unique set of historical circumstances rooted in a reactionary cross-generation alliance between the state, the Church and a well-heeled doctor-consultant class. In 1951, at its zenith, this bloc forced out health minister Noel Browne, who, awe-struck by the immediate successes of a young NHS, proposed a measure to make healthcare services free for mothers and children up to the age of 16.
But the great irony in suggestions that the NHS ought to be more like the HSE is that Irish healthcare is, at least on paper and in rhetoric, undergoing a gradual process of universalisation, particularly with regard to GP fees.
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[1] Url:
https://www.opendemocracy.net/en/nhs-strikes-ireland-pay-gp-a-and-e-sajid-javid-uk-gordon-brown/
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