UHI White Paper
UHI Unit
Department of Health
Room 7.26
Hawkins House
Hawkins Street
Dublin 2
28th May 2014,
Re: Public Consultation on the White Paper on Universal Health Insurance
I am responding as Chairperson of the Health Linkage Group of the Community and
Voluntary Pillar in relation to the Public Consultation on the White Paper re Universal Health
Insurance. The Community and Voluntary Pillar consist of seventeen representative organisations
(Appendix 1) invited by Government to provide voice and representation for vulnerable people and
communities in developing Ireland’s social and economic policies. They are a very specific grouping
of committed people with the experience, knowledge and understanding of health policy
development in Ireland. They have had a strong track record of meaningful engagement and
consultation with senior health policy makers via social partnership and other policy fora.
The Health Linkage Group holds a unique position as a key stakeholder as our constituents are
community and voluntary groups working close to those most vulnerable in our communities, in
partnership with State bodies. We work across the life cycle providing a very specific insight into the
health inequalities and disadvantage experienced by various groups including people with
disabilities, travellers, lone parents, women, older people, the unemployed, and carers and families.
Therefore we are uniquely positioned to understand and witness how important a function public
health system is for the overall health and wellbeing of the population.
We believe that this experience and insight is particularly valuable in the context of the current
health service reform programme.
The following are our key concerns:
Inadequacy of Consultation process. We believe the timescale for receipt of submissions is
too short for what is being presented as the ‘most fundamental reform of the health
system’. We believe there is a need for greater explanation and awareness raising among
the community and voluntary sector groups in relation to the proposed changes as well the
need for an extension to the consultation period.
Broader Debate Required. We believe that the UHI model proposed, based on the Dutch
system, narrows the debate in relation to UHI. There is a need for broader debate which
takes account of UHI models in other countries.
Need for a public health service. We believe Ireland should have a progressive tax based
public health service and UHI is not progressive.
Commitment to equality and fairness. The World Health Organisation has recently provided
guidance on Universal Health Coverage. The report of their Consultative Group on Equity
and Universal Health Coverage states that countries must advance in at least three
dimensions. ‘Countries must expand priority services, include more people, and reduce outof-pocket payments. However, in each of these dimensions, countries are faced with a
critical choice: Which services to expand first, whom to include first, and how to shift from
out-of-pocket payment toward prepayment? A commitment to fairness—and the
overlapping concern for equity—and a commitment to respecting individuals’ rights to
health care must guide countries in making these choices. For fair progressive realization of
UHC, the three critical choices and the trade-offs between the dimensions must be carefully
addressed.’ We believe that attention to these issues is inadequate in the UHI model being
consulted upon.
Inadequate Information. The proposed model of UHI in this consultation process does not
provide enough information. There is no clarity as to what will be contained in the ‘health
basket’ and an inherent danger that discrimination could occur for some groups with rare
diseases, or that those covered by the long term illness scheme, could be vulnerable in the
new ‘commissioning approach’.
Unfortunately the time constraints involved does not allow us to put together a more
detailed response to this consultation process however we hope you can address some of
these key concerns in your deliberations on UHI.
Yours sincerely,
__
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John Dolan
Chairperson C&V Health Linkage Group,
C&V Pillar.
Appendix 1
The members of the Pillar are:
1. Age Action Ireland
2. Children’s Rights Alliance
3. Congress Centres Network
4. Disability Federation of Ireland
5. Irish National Organisation of the Unemployed
6. Irish Rural Link
7. National Association of Building Co-operatives
8. National Women’s Council of Ireland
9. National Youth Council of Ireland
10. Protestant Aid
11. Social Justice Ireland
12. The Carers Association
13. The Community Platform
14. The Irish Council for Social Housing
15. The Irish Senior Citizens Parliament
16. The Society of St. Vincent De Paul
17. The Wheel