May 30, 2020
News Opinion

MICHAEL WOLSEY: If we’re going to copy a health system, let’s copy the best

If we were to compile a European league of success in handling the Covid crisis there is no doubt that Germany would be up with the best and the UK down near the bottom.

The German government moved swiftly to impose a disciplined lockdown whereas Britain’s leaders dithered and dallied, issuing confusing and often contradictory advice.

But it wasn’t only the quality of leadership that made the difference. Germany’s health system was in good working order from the onset of the crisis. It wasn’t short of respirators or protective clothing. It wasn’t short-staffed and there was no danger of its intensive care wards being swamped.

By contrast, Britain’s National Health Service, once the envy of the world, was creaking at its joints – the staff overworked and hospitals under-funded.

So it surprises me when I hear people say that Ireland should follow the NHS model.

It is a mantra repeated frequently when discussion turns to what our health system should look like after the Corona crisis has passed.

Certainly we should not go back to the system we had, which creaked even more than Britain’s. But if we are going to copy a model, surely we should look at one of the best, not one that has failed.

And the German model has a practical advantage, in that its broad structures are not so very different from our own. It, too, mixes private and public health care, using the same staff and, in most cases, the same hospitals and clinics.

The big difference is that all German residents must have health insurance.

For people earning less than €62,550 (not a bad annual salary, even by German standards) the insurance is paid for by employers, employees and the government via tax concessions.

The insurance is provided by a number of not-for-profit ‘sickness funds’, strictly regulated to ensure value for money.
If you earn more, you can top up your benefit with insurance bought from a private company. This will get hospital patients a private ward,  probably a nicer ward, and their choice of doctor. It may also push them up the waiting list for elective treatment, although waiting lists in Germany are so short that this isn’t really an issue.

Germans can also opt for entirely private treatment in facilities built and financed by private companies, but this is so expensive only the very wealthy choose to do it.

Everyone else is in the same boat, although some are travelling in the first-class lounge.

Everyone ends up getting the same level of care in the same hospital.  If you can afford it – and choose to spend your money that way – you can have the deluxe package, but the difference won’t be huge.

Since the money spent on the German health system comes from insurance funds, it is ring-fenced and does not go up or down with the economy or at the whim of governments. This has allowed for steady, consistent investment in health, which is why the German system works so well.

Sláintecare, the ten-year programme to which all Ireland’s main political parties have given nominal support, is committed to providing health insurance for everyone under a National Health Fund.

It aims for a “single tier health system” but is vague about what that actually means and about what will happen to all the people who have made a lifetime investment in private health insurance and what will happen to health funding if they all withdraw from that insurance.

Sláintecare seems intent on eliminating choice whereas the German system encourages it within clearly defined boundaries.
It squares as well with Sláintecare as the British system does and is a better example to follow than that of our sadly ailing neighbour.

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