Ireland is unique among its European counterparts in that, unlike them, we have no universal access to healthcare. Since 2011, both Programmes for Government have committed to the goal of universal healthcare.
Building on our prior work for the Resilience project, the Pathways project is mapping a potential pathway or pathways to universal healthcare through the three components of the research project:
- Assessing the gap between current Irish health system performance and universal healthcare, using and adapting World Health Organisation concepts;
- Evaluating the strengths and weaknesses of different models of universal healthcare and assessing their feasibility of implementation within the current context according to key criteria such as affordability, human resources and complexity of design;
- Assessing the organisational challenges of moving to universal healthcare by reviewing the experience of other countries and exploring the current capacity and constraints facing decision makers throughout the system.
Background – Universal Healthcare in a global context
In 2005, all World Health Organisation (WHO) member states, including Ireland, committed to Universal Health Coverage. The UN General Assembly, in 2012 and the 2013 WHO World Health Report, reiterated the 2005 commitment to Universal Health Coverage. According to the WHO, the 'goal of universal coverage is for everyone to obtain the services they need at a cost that is affordable to themselves and the nation as a whole'. Universal Health Coverage achieves better health outcomes for individuals and whole populations.
Definitions of Universal Health Coverage
The WHO uses the following main definition of Universal Health Coverage (UHC):
Universal coverage is defined as access to key promotive, preventive, curative and rehabilitative health interventions for all at an affordable cost, thereby achieving equity in access. The principle of financial-risk protection ensures that the cost of care does not put people at risk of financial catastrophe. A related objective of health-financing policy is equity in financing: households contribute to the health system on the basis of ability to pay.
The WHO uses a cube to demonstrate the three facets of Universal Health Coverage (UHC) as specified below.
Source: WHO website
The WHO identifies three dimensions to universal health coverage:
- The package of services or care that is needed;
- The coverage of the population that need them;
- The price paid at the point of contact for those services.
In a 2014 joint WHO and World Bank report, Universal Health Coverage was defined as:
A situation where all people who need health services (prevention, promotion, treatment, rehabilitation, and palliative) receive them, without undue financial hardship. UHC consists of three inter-related components:
• The full spectrum of quality health services available according to need;
• Financial protection from direct payment for health services when consumed;
• Coverage for the entire population.
Universal Healthcare in Ireland
In an Irish context, there may also be other issues which need to be considered – beyond the cube – such as issues of geographical access and the numbers and length of waiting times for diagnosis and treatment.
A systematic review of literature on universal health coverage found that the term ‘universal healthcare’ was ‘was most frequently used in describing policies for care in high-income countries, while universal health coverage was most often applied to low and middle-income countries’ (Stuckler 2010). The term ‘universal healthcare’ is being used for this project.