An independent review of health care in the island will look at whether services should remain free.

Other options that could be considered might include a ’health tax’.

Treasury Minister Alfred Cannan made clear that the root and branch review of Department of Health and Social Care’s services and funding will cover all options.

It has been commissioned in a bid to end the annual process of the cash-strapped DHSC coming to Tynwald cap in hand, asking for extra millions to cover overspends.

At the same time as backing the review, Tynwald also approved an extra £9.5 million being awarded to the department to cover this year’s excess expenditure.

The review would address many issues, Mr Cannan said, including: ’Is the assumption of health services being largely free at the point of use for all still valid for the future - and what sort of alternative system might be appropriate for the Isle of Man?

’Should this principle continue, then should the scope of what is free at the point of use be more restricted? For instance, could certain procedures be charged for or made available on a means-tested basis?’

Other areas the review would need to cover include:

â?¢ Is the current ’funding envelope’ for the range of DHSC services realistic and how is funding likely to change over the next 15 years?

â?¢ What alternative models to the current state-provided services exist. How would any other model impact on quality of service?

â?¢ What would be the best model to ensure ’financial stability and sustainability’.

Mr Cannan added: ’What is the scope for changes to current funding streams and co-payment methods, for example a hypothecated health tax, increases to National Insurance levels, lifestyle ("sin") taxesâ?¦etc?’

Members voted in favour of Mr Cannan’s motion for a Council of Ministers-commissioned review to ’determine change options for service delivery and funding to provide a modern, fit for purpose health care system’.

The Minister said the review would not be cheap and would need to be headed by a ’well-respective impartial individual with sufficient gravitas and intellectual capability’.

CoMin will report back to Tynwald by January.

Mr Cannan warned: ’It cannot be seen as acceptable for the DHSC to continually exceed its budget each year and seek a supplementary vote from Tynwald and, in doing so, jeopardise our targeted plans and probably lead to restricted funding available for other areas of the public service.

’It is not new for the DHSC to overspend, but not at the levels we are currently seeing: £9.9m in 2016, £11.1m in 2017 and now £9.5m in 2018 - £30.5m deficit funding required in the last three years and that is in addition to the £11m we gave the department in additional funding in last year’s budget.’

He added: ’I do also recognise that at the same time it is also not acceptable to expect the department to deliver a range of services for which it is not adequately funded.’