FOLLOWING the last week’s developments in the national health scheme (Gesy) saga, it is rather difficult to be optimistic about the prospects of its implementation. If anything, it is shaping into a major fiasco, with private doctors threatening not to join, drug importers questioning the budgeting, private hospitals claiming proposed charges for use of their services was too low and the Health Insurance Organisation (OAY) insisting that it cannot deviate from its budget.
Add to this, forecasts from government quarters that even if everything went according to plan, Gesy would have a deficit in excess of €300m and it becomes apparent that meeting the implementation deadlines set by law is a massive challenge. Meanwhile, the Employers and Industrialists Federation (OEV), perhaps aware Gesy would go over budget, has been issuing warnings that it would cause big financial problems for businesses that would be paying monthly contributions for their employees. Who, after all, would pick up the tab if the scheme eventually goes over budget?
Despite all these very real difficulties, there is zealous popular support for Gesy. A grouping made up of unions and patients’ organisations known as the Social Alliance for the implementation of Gesy has stepped up its campaigning and has been taking to task anyone that does not fully embrace the Gesy faith. All attempts made that “are against the law and change the framework and philosophy of Gesy, will find us in front of them,” said the Social Alliance after a meeting on Wednesday. It also announced meetings with political parties to push its demand and warned that it “would take measures if the need arose.” It would also consider holding a mass rally, a newspaper reported.
While it is perfectly understandable that people are passionately in favour of a scheme that would provide free healthcare to everyone, they have to understand that a viable Gesy cannot be implemented with slogans, mass rallies and high emotion. What is required is in-depth study of all practical aspects of the scheme, detailed financial and organisational planning, a well-functioning IT system, the establishment of an efficient management structure and having all stakeholders on board to mention a few. Very little of this has been done yet, even though the HIO has been in existence for more than ten years, supposedly taking care of all preparations. It suffices to say that in these ten years the development of the software programme that is of vital importance for the administration of the scheme has still not been completed.
The existence of laws stipulating implementation dates for the different stages of the scheme, cited by the Social Alliance, is meaningless when there is still so much to been done. Now, the HIO is in dispute with private doctors, who are understandably unwilling to join a scheme that will underpay them, set limits on their earning capacity, lower their pay rates if they work hard and see many patients, and will force them to do hours of paper work every week to get paid. As for psychiatrists, they have not been included in the scheme, the HIO saying it would deal with this oversight at some point in the future, presumably before the implementation deadline.
At the same time, private hospitals and clinics have been saying the rates they would be paid for the examinations requiring expensive medical equipment would bankrupt them. A private hospital doctor remarked that a piece of equipment recently purchased, would be written off after 50 years at the charges for use proposed by the HIO. This suggested equipment would not be modernised or updated for decades as it would make no financial sense.
And while private hospitals are being expected to offer their services at cut rates, the costings for the operation of state hospitals that would be a guide of what should be charged, have still not been calculated. The excuse is that state hospitals would become autonomous, self-sustaining entities in five years, according to the law, but will they? A more likely scenario is that inefficient state hospitals with public sector work conditions will be the biggest drain on Gesy, because no politician would dare take on the pampered staff that are paid overtime rates if they are working after 3pm.
The problems the HIO is having with the doctors are certain to arise when it enters proper discussions with the pharmacy owners and drug importers. These are only just starting and neither of these stakeholders will accept the restrictions that would be imposed on them because the HIO would want to stay within its budget. This budget, close to a billion euros, is increasingly looking inadequate for funding a reliable and well-functioning system of universal healthcare, something the HIO would have realised much sooner if it had carried out meticulous and detailed research of the healthcare sector.