Minister for Primary Care Alex White has not ruled out the introduction of co-payment by patients as part of the universal GP care scheme due to be launched in 2016.

However, he has stressed that co-payment, under which patients make a contribution to the cost of a GP visit, would not be part of the free GP care scheme for under sixes. This scheme is due to be introduced this year, although the Minister is at loggerheads with the GP organisations over the proposed contract for the scheme.

Asked if some patients would have to make a contribution towards their care under the 'free' GP scheme for the entire population in 2016, Minister White said he was not putting forward definite proposals for a co-payment system.

"However, I understand the case that is made for a modest co-payment. But there will be no co-payment and no charge, nominal or otherwise, for the under sixes scheme."

In an interview with irishhealth.com, the junior health minister said he was currently developing a paper for Government on how the full GP scheme for the entire population can be rolled out.

He said arguments for funding systems such as co-payment could be made in that context.

Minister White said the timeline for the introduction of the under sixes scheme was still the middle of this year and it was planned to introduce the universal GP scheme by 2016.

Asked if the Labour Party would not prefer a UK-type national health service instead of James Reilly's universal health insurance scheme, Mr White says Labour had in fact proposed a UHI type system over 10 years ago.

"While an NHS or exchequer-funded system does have a lot of attractions, there is also a lot of evidence that an insurance-based system is a more efficient distributor of a resource than the direct exchequer-funded system."

Would Labour have qualms about the UHI system being effectively run by insurance companies?

"The system will not be actually run by insurance companies, because while there will be competing insurers there will be a public option - the VHI will be maintained- and it will be a highly regulated market."

He does not feel that having a plethora of 'quangos' under UHI is an issue.

"If there is clarity about what the function of a new body is, and if it is efficiently run I don't think having three or four new bodies involved is necessarily a danger or risk. The publication of the White Paper on UHI will afford an opportunity for a wide public consultation process. We need to have this public debate about our health service and how we fund it. A lot of the components - abolition of the HSE, purchaser provider-split, would have been happening anyway even if we didn't have UHI."

Meanwhile, the doctors' union, the IMO, has warned Minister White and the Government that their plans for free GP care were doomed to failure unless there were full negotiations with GPs on all aspects of the contract.

Minister White told irishhealth.com that there was bad atmosphere at present between the Government and GPs and said the draft contract that had been rejected by the GP bodies could be changed in talks with GP representatives.

However, he said while GPs could have an input into the fees to be paid under the under sixes scheme, they could not directly negotiate on specific fee levels, as a result of current restrictions in competition law.

The IMO said today Minister White's insistence on ruling out negotiations on resources 'effectively ruled out negotiations on everything'.

The union said it had written to Minister White stressing that a negotiation which addressed the scope and content of the under six free GP care scheme without addressing what GPs are to be paid for delivering the service was 'impossible and meaningless'.

The IMO warned it may be forced to take court action if the Government proceeded to introduce the under sixes scheme without full negotiations with the IMO.

Minister White was heckled at a meeting in Clonmel at the weekend organised by the Irish College of GPs.

See also irishhealth.com's interview with Minister White.