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Healthcare Policy in a Reunited Ireland
 One
of the key measures of a high-functioning society is the health of
its people. Today, the countries that index high on such healthcare
measures share a common core value --- the belief that every
citizen, regardless of socioeconomic status, deserves quality
healthcare that is accessible and egalitarian.
In both the Republic of Ireland (Ireland) and Northern Ireland,
universal health care is presently a legislative mandate. The
quality of healthcare in both states is above par however, the
delivery in both is subpar attributable to myopic management and the
absence of long-range planning and definable goals. Poor policy
decisions are responsible for a shortage of hospital beds, long wait
times for testing and elective surgical procedures and also for the
lack of adequate emergency care in remote areas. In the last twenty
years, the Irish government has reorganized the health care system
four times in an attempt to overcome deficiencies. Once again it is
in the process of reorganizing the existing Health Services
Executive into six regional areas in an attemptto eliminate the inherent
disadvantages associated with centralization.
Ireland is one of a few countries in Europe where healthcare is
wholly planned and managed by the national government.
Therein lies the problem. It’s a fact universally acknowledge that
government bureaucracies are inherently
inefficient, particularly in the delivery of services, including
healthcare.
Countries with exceptional healthcare rely on the private sector to
implement the actual delivery by leveraging efficiencies inherent in
flexible management structures and honed by competition.
Under the proposed Eire Athaontaithe (Reunited Ireland) constitution,
healthcare will be categorized as a fundamental right accessible to
all lawful residents of the state. As Ireland would be a federal
republic after reunification, healthcare will no longer be an
exclusive national government function. Regional healthcare
authorities would be responsible for the management of healthcare
delivery systems and organizations, quality assurance, compliance
and enforcement. An Inter-Government
Healthcare Executive (IGHE) will be responsible for healthcare
policy, drafting legislation, creating regulations, and developing
quality and compliance procedures and best practices. The IGHE will
retain sole responsibility for the management of data storage and
retrieval systems for all healthcare related records for the
regions.
The transition of healthcare
from the existing centralized system to the new regional
decentralized system must be planned and implemented seamlessly.
That being so, it would be logical that the resources utilized by
the existing healthcare system including manpower, health records,
equipment, databases, and other documentation would constitute the
basis for the new decentralized system. It's important to keep in
mind that irrespective of the form a reunited Ireland will take, a
transition period will be built into the process to allow for the
revamping and merging of government institutions and networks.
Healthcare, together with all other reunification related issues
will be dealt with during that transition period.
The IGHE will be headed up by a Board of
Directors (BOD) composed of the three regional healthcare administrators
and a national healthcare director. The national healthcare
director will chair the BOD but, will have no voting rights. The IGHE will
be staffed by policy and legislative experts, healthcare
professionals, managed-care professionals, data management
specialists, and other specialties as required. The IGHE will be
supported by an administrative staff. During the transition period,
the IGHE management staff will work with a healthcare transition
task force to handle the transfer and realignment of
responsibilities and resources to the new decentralized healthcare
system.
With the exception of responsibilities assigned to the IGHE, all
other healthcare responsibilities will be handled by regional
governments’ healthcare departments. Basic healthcare legislation
common to all regions will be drafted by a subgroup of experts
within the IGHE with input from regional healthcare administrators.
That draft legislation will set forth basic requirements that all
regional healthcare legislation must adapt as the basis for their
respective healthcare legislation.
After the cost and delivery of healthcare services become the
responsibility of regional governments, the focus will be on
ensuring that high-quality healthcare is available to everyone in
the most cost-effective and sustainable way possible. To that end,
every effort will be made to ensure that the financial burden in
delivering healthcare is not disproportionally borne by taxpayers
and privately insured individuals and families. It’s a given that a
certain percentage of any population cannot afford to pay for
healthcare under any circumstance. It’s a national responsibility to
ensure that their healthcare needs are provided for. It’s also a
given that there is a percentage of the population that can afford
to contribute at some level to the cost of their healthcare but
choose not to, simply because they can get it for free. For that
very reason they tend to under-value and over-utilize the system,
unnecessarily stressing it to the detriment of all.
Two countries with highly rated healthcare systems in Europe, the
Netherlands and Switzerland, require all citizens to purchase basic
healthcare insurance. In the Netherlands everyone is required to
purchase insurance coverage from either private insurers or from the
government’s insurance program, the choice dependent on the
individual’s earnings. In Switzerland everyone must also purchase
basic healthcare insurance from a host of private insurers.
Subsidies are available in both countries for individuals who cannot
afford the cost. Supplemental coverage is also available in both
countries for items such as dental and vision not covered by basic
insurance.
If Ireland utilized an approach to healthcare funding similar to
either the Dutch or Swiss model, it would bring equity to the system
and provide a foundation on which to build a cost-effective and
sustainable system going forward. To that end, healthcare policy
including legislation, regulations, and
compliance would remain an inherant government function. Nonprofit managed-care organizations, insurers, health
care providers and ancillary healthcare services would be utilized
to manage and deliver healthcare at the regional and local level.
Cost efficiencies
integral to the success of nonprofit organizations including cost
sharing, electronic health records,
patient portals, value-based care, telemedicine
services, safety programs etc, would be ploughed back into the
system. On the other hand, a substantial portion of savings generated by for-profit enterprises is used for
executive compensation
and investor distributions.
Reinvesting in the system to increase hospital beds, eliminate
excessive waiting times for surgical procedures and provide
around-the-clock emergency care access to under-serviced areas will
in time reduce the overall cost of
healthcare, produce better outcomes and create a model for
sustainability.
TMMTP
Date posted 8/6/2022
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