Sláintecare

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Sláintecare is a proposed reform of the healthcare system of Ireland. Pronounced /ˈslɔːntʃəkɛər, ˈslɑːn-/ SLAWN-chə-kair, SLAHN-, the name is derived from sláinte [ˈsˠl̪ˠaːnʲtʲə], the Irish language word for "health."

The intent of the Sláintecare reforms is to achieve a universal single-tier health and social care system, which provides equitable access to services based on need, and not ability to pay. Currently, Ireland is the only state within the EU which does not provide universal healthcare, according to WHO criteria.[1][failed verification] The Sláintecare programme enjoys the support of all parties in the Oireachtas.

History[]

Initial proposal, planning, and early rollout: 2011-2020[]

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.[5] 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.[5]

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.[6] 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.[7] 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.[8] 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.[9] In May 2017 the committee published its final report entitled “Committee on the Future of Health, Sláintecare Report[10]”, 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[11]

The document entails a proposed ten-year plan for reforming the Irish health system towards universal healthcare.[11] It consists of five sections, covering Population health profile, Entitlements and Access to Healthcare, Integrated care, Funding and Implementation.[11] 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.[9] 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.[11] 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.[9] Laura Magahy was appointed as director of the Sláintecare programme in 2018. She resigned from her position in September 2021.[12]

In December 2019, Minister for Health Simon Harris estimated that the reforms would be carried out by 2030 as a result of the government's decision to only issue new contracts for public-only consultants, although an exact timeline on how long it would take to switch over to an entirely public health service would depend on the uptake. By 2030 he expected the government would have recruited an additional 1,000 consultants.[13]

COVID-19 pandemic and onwards: 2020-present[]

In June 2020, Róisín Shortall, chair of the committee which established the plan, said that delays on funding until 2022 meant the plan "now seems to be completely relegated to some point in the future".[14]

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. ^ a b 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. PMID 26777302.
  3. ^ a b 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. ^ "Programme for Government 2011-2016: Fairness". Department of the Taoiseach. 2011. p. 31. Archived from the original on 27 June 2018.
  5. ^ a b c "White Paper on Universal Health Insurance" (PDF).
  6. ^ 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. 14 (3): 355–373. doi:10.1017/s1744133117000275. ISSN 1744-1331. PMID 29277162. S2CID 5930127.
  7. ^ Clements, Richard (October 2016). "3. Prime Minister and Cabinet". Law Trove. 1. doi:10.1093/he/9780198745259.003.0003. ISBN 9780198745259.
  8. ^ "Committee on the Future of Healthcare (32nd Dáil)". Oireachtas. Archived from the original on 3 June 2021.
  9. ^ a b c 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.
  10. ^ "Sláintecare: Publications". gov.ie. Archived from the original on 3 June 2021.
  11. ^ a b c d "Committee on the Future of Healthcare Committee on the Future of Healthcare: Sláintecare Report" (PDF). Oireachtas. May 2017. Archived (PDF) from the original on 3 June 2021.
  12. ^ Wall, Martin (September 8, 2021). "Head of Sláintecare health reform programme resigns". Irish Times.
  13. ^ Brennan, Cianan (2019-12-30). "Minister believes Sláintecare reforms will be completed before 2030". irishexaminer.com. Retrieved 2021-01-18.
  14. ^ O'Halloran, Marie (17 June 2020). "Sláintecare 'relegated to sometime in the future' in programme for government". The Irish Times. Archived from the original on 25 January 2020. Retrieved 18 January 2021.
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