Free GP Care an Essential Element of an Effective Health System

The government has decided to extend free GP access to all children aged 5 and under. It is a move that will benefit many young families. But it is much more than a budget ‘gain’ for one group or sector. Rather, it is the first step in achieving universal access to GP care without fees, and the ultimate transformation of our health services.

Health budgets worldwide are under enormous pressure because of rising costs, ageing populations, and the ever-increasing challenges associated with illnesses such as diabetes, cardiovascular and other chronic diseases. We need a radical shift in the way we manage our health system.

The best way of starting would be to facilitate easier access to GP services, so that health problems are identified before they get serious, and people get guidance on how to manage their lifestyle - to avoid becoming ill.

The evidence is clear that people delay or avoid visiting their GP where a fee is required, and this cost barrier is not confined to the less well-off. We should remove this barrier, and extend access to GP services without fees to the whole population.

There is a good reason why GP care without fees is the norm in Northern Ireland, Britain and across Europe: because it makes sense and it works. Far from being a “stunt” or a gimmick, it is an essential step towards the achievement of an effective and equitable health service for all our citizens.

It has been suggested by some that healthcare should be targeted, and not made universal. But for our health system to succeed we need to “target” the entire population. The old approach of waiting for people to become sick before we intervene is just not going to work for the future.

Others have questioned why we are starting with young children. Along with older citizens, young children constitute a public health priority. If we can provide the right interventions at early ages, we can make a huge difference for people in their middle and later years. The evidence for this quite simply is indisputable.

It has been suggested that this measure will favour the wealthy at the expense of people in greater need. This is not so. The vast majority of families to benefit from this initiative are average, working families on low or middle incomes – they are hardly millionaries.

Even if a small number of wealthy people no longer have to pay to bring their children to the doctor, it is right that we should have a universal service in primary care, just as we have for services like child health screening and surveillance programmes, or immunisation. Does anyone question the fact that wealthy parents do not pay for their children’s primary school education?

The controversy over discretionary medical cards points up a fundamental issue:  in a modern civilized society, the allocation of healthcare should not be based on discretion or a means test. It should be a basic right. And the funding of healthcare at all levels – whether through taxation or insurance – should ensure fairness by requring that citizens contribute to that funding in accordance with their income.

This government has to address two sets of challenges simultaneously. On the one hand, we must maintain the current inadequate system in a fair and prudent manner. On the other, we must pursue a radical reform programme to end our two-tier healthcare structure.

Full universal access to GP services is a critical first step, and an essential one if we are to have any chance of addressing the health needs of the Irish people in the years and decades ahead.

Alex White is Labour TD for Dublin South and Minister of State for Primary Care