Extending free GP care to whole Irish population ‘could cost up to €881m’

Extending free GP care to everyone in Ireland, using a gradual approach based on people’s income, could cost the state between €381 million and 881 million euro by 2026, according to research.

The lower amount is based on a low-pressure scenario while the higher figure is in the event of high demand.

“A take-up rate of 70% rather than 85% would reduce projected cost by approximately 18%, while increasing the take-up rate from 85% to 100% would increase projected cost by almost 18%,” the research funded by the Department of Health said.

A paper published on Tuesday by the Economic and Social Research Institute (ESRI) estimated there would be an extra 2.3 million visits to GPs in 2026 if care was gradually rolled out for free based on age.

This represents a 12% increase on if there were no changes to who gets care for free.

As it stands, children aged five and younger and people aged 70 and over have access to free GP care, while others can get access for free based on their income.

As of 2019, around 56% of the population did not have a medical card or a free GP visit card.

As part of the Slaintecare plan, which has received cross-party support, GP care would be free for the whole population, bringing Ireland in line with public healthcare in other European countries.

The ESRI research estimated the cost by comparing two different rollouts: one based on age and the other based on income.

The analysis also used varying assumptions about population growth and ageing, take-up rates and payments to GPs.

The cost to the state of extending free GP care to everyone in 2026 was estimated at €462 million to €881 million using the age-based approach, and €381 million to €881 million using the income-based approach.

The lower cost for the income-based approach is due to the assumption of lower take-up.

In the age-based approach, it is assumed that free eligibility will be introduced in 2023 for children aged six and seven, in 2024 for people aged 50–69, in 2025 for those aged eight to 17, and in 2026 for people aged 18–49.

Under the income-based approach, researchers assumed that current income thresholds for a GP visit card would be extended in 2024, 2025 and 2026 so a third of people without free GP care would become eligible each year.

Higher costs are associated with higher take-up rates and payments rates for GPs.

The report concluded that if free GP care was extended to the total population over a “relatively short period of time”, an age-based approach could be a “pragmatic option” to ensure high take-up rates.

“However, if the extension of eligibility occurred over a longer period of time (eg, over a 10-year period rather than the four-year period considered in this analysis), then extending eligibility via the income approach would seem a more equitable option,” the report said.

Lead author of the report, Dr Sheelah Connolly, said: “The Slaintecare Report noted the need to move towards a universal healthcare system for Ireland.

“Increasing the number of people entitled to free GP care would help achieve this objective.

“However, there may not be a sufficient number of GPs available to deliver the additional visits associated with the ageing and growing population, as well as an increase in the number of people eligible for free GP care in the coming years.

“If there are not sufficient GPs to meet the additional demand for their services, then, while financial barriers to access may be removed, other barriers including long waits or no availability could hinder access, thereby undermining the universality of the system.”

The projected costs include an expectation of projected population growth and ageing, take-up rates, increases in payments to GPs between 2019 and 2022 – as detailed in the 2019 agreement between the Department of Health, the HSE and the Irish Medical Organisation – and additional cost growth between now and 2026.