Health Insurance Hikes

Dannyboy83

http://www.independent.ie/business/personal-finance/latest-news/families-face-new-300-hike-in-health-insurance-cover-3270958.html
The Irish Independent has learned that the four insurers -- VHI, Laya, Aviva and Glo -- are set to hike their premiums by between 10pc and 15pc again from the start of the New Year.

Some 2.1 million people have private medical insurance, but around 6,000 people a month are being forced to drop their cover.

I'm curious as to the strategy of the Health Insurance companies.

Basic arithmetic tells you that price hikes which lose 6000 customers per month can only result in more price hikes.

1. Why is health becoming less competitive when most of the economy becomes more competitive?

2. Are the insurance companies purposely shedding customers to reduce exposure?

3. Why are there 4 separate companies if they all increase prices simultaneously? There doesn't seem to be any competition there - seems like a cartel. Might make more sense to just have a single mandatory UHI company if there is no competition?

The rises are to cover an increase in healthcare claims, spiralling health inflation to cover the cost of new drugs and procedures, and the expected rise in the cost of the levy on private healthcare of up to €200 per family.

4. How can it make sense for the state to enforce a levy on private health insurance, which increases the likelihood that the state will end up paying rather than the health insurance company?

jester77

What does private health insurance cost in Ireland at the moment?

From the article it mentions prices will rise to €2300 for a family with 2 children. I presume that is per year? It sounds too high to be monthly but it also sounds too low to be yearly.

I have private health insurance in Germany and I have the most basic and cheapest plan available which costs me €420 a month and I then have to cover the first €800 of medical costs per year before I can claim anything back from the insurance company. That is just a basic plan for a single person, I know it would cost me a lot more to add 2 children to it.

It seems to me that health costs in Ireland are all over the place and that the system needs a total overhaul.

I was talking to a friend in Ireland this week who recently had a baby. His wife was meant to have a visit from the gynecologist while in hospital but it never happened, yet when the bill arrived there were costs on it for the gynecologists visit. My friend queried this with the hospital and they said that it standard procedure to charge this and that the hospital would take care of it.

If thats the way things work in Ireland then I'm not surprised there are huge issues with the health system and that insurances have to go up.

yop

Myself and my wife have the 2nd level of cover with GLO and an addon for Daily expenses of the highest level.
This costs us 185 euro per month.

In the last 2 years our health cover has gone up 70 euros per month. Another hike and it will have to go.

GCU Flexible Demeanour

Dannyboy83 wrote: »

<..> Basic arithmetic tells you that price hikes which lose 6000 customers per month can only result in more price hikes.

Why is health becoming less competitive when most of the economy becomes more competitive?

Bear in mind that health insurance is demand inelastic. Put simply, that means that the companies can be fairly certain that less than 10% of their clients will drop cover in response to a 10% increase – so their overall earnings will still increase.

Dannyboy83 wrote: »

There doesn't seem to be any competition there - seems like a cartel. Might make more sense to just have a single mandatory UHI company if there is no competition?

I’d say yes. I think it’s pointless talking about competition in health care, because it’s just not a normal product; if heart transplants were on special offer, would you buy two?

Dannyboy83 wrote: »

How can it make sense for the state to enforce a levy on private health insurance, which increases the likelihood that the state will end up paying rather than the health insurance company?

Bear in mind, the point of the levy is just to support community rating – it’s to guard against any insurer concentrating on signing up younger, healthier people, while leaving the heavy claims with some other insurer. So, arguably, the levy helps to keep private cover affordable for people who might otherwise be placing heavy demands on the public system.

If the young and healthy tend to drop out of private cover, it won’t cause much of a problem for the public system.

creedp

jester77 wrote: »

What does private health insurance cost in Ireland at the moment?

From the article it mentions prices will rise to €2300 for a family with 2 children. I presume that is per year? It sounds too high to be monthly but it also sounds too low to be yearly.

I have private health insurance in Germany and I have the most basic and cheapest plan available which costs me €420 a month and I then have to cover the first €800 of medical costs per year before I can claim anything back from the insurance company. That is just a basic plan for a single person, I know it would cost me a lot more to add 2 children to it.

It seems to me that health costs in Ireland are all over the place and that the system needs a total overhaul.

I was talking to a friend in Ireland this week who recently had a baby. His wife was meant to have a visit from the gynecologist while in hospital but it never happened, yet when the bill arrived there were costs on it for the gynecologists visit. My friend queried this with the hospital and they said that it standard procedure to charge this and that the hospital would take care of it.

If thats the way things work in Ireland then I'm not surprised there are huge issues with the health system and that insurances have to go up.

Probably the primary difference between insurance costs in Germany and here is that in Germany the premium is suppoed to reflect the full cost of providing you with health services, i.e. it funds the public health system, whereas in Ireland it simply provides private patients with top up cover in public hospitals as well as access to private hospitals. You will, as a taxpayer, have also contributed to the €13bn provided to the HSE to provide a public healthcare system. When you add private insurance and individual tax contribution to health together, health [insurance] costs are not cheap in this country compared to Germany.

In relation to the consultant fee, this is where the Irish system is simply unsustainable. You have a consultant being paid a salary to provide public hospital services in a public hospital. You happen to be private to this consultant in the public hospital and even though he is paid to provide this service he can now also charge you a private fee - a bit like official nixers!! Imagine if a guard could charge you a fee on top of his salary for calling to your house to investigate a robbery where he has prioritised your call over some other poor b*astard who couldn't afford this fee!! How long would this scenario last??

Nody

Dannyboy83 wrote: »

Why is health becoming less competitive when most of the economy becomes more competitive?

Because like all types of insurance is based on investing (or in some cases speculate) the money you pay them into stocks/bonds to generate money to pay back your future claim. The problem is bonds are at a level of giving negative interest (i.e. you pay to own them, not joking) and stocks are in general tanking accross the board. This means that that profit they could previously generate on your money is no longer coming in and all people with insurance need to step up and cover the gap basically.

Icepick

Dannyboy83 wrote: »

1. Why is health becoming less competitive when most of the economy becomes more competitive?

public sector inefficiencies

Dannyboy83

GCU Flexible Demeanour wrote: »

Bear in mind, the point of the levy is just to support community rating – it’s to guard against any insurer concentrating on signing up younger, healthier people, while leaving the heavy claims with some other insurer. So, arguably, the levy helps to keep private cover affordable for people who might otherwise be placing heavy demands on the public system.

If the young and healthy tend to drop out of private cover, it won’t cause much of a problem for the public system.

But what about a scenario where it causes younger people to drop out of the private system? (which it appears to be doing unless I'm interpreting incorrectly)

Is it not then a vicious circle of an ever rising cost base/ever depleting customer base?

GCU Flexible Demeanour

Dannyboy83 wrote: »

But what about a scenario where it causes younger people to drop out of the private system? (which it appears to be doing unless I'm interpreting incorrectly)

Is it not then a vicious circle of an ever rising cost base/ever depleting customer base?

Oh, yes, you are right there. Ultimately, and over time, there absolutely is a risk of what's termed a death spiral - where the only people left in the pool are high risks, which makes it pointless to take out insurance as the cost will start to rival what it would cost to just pay directly for the medical care.

The problem is health risks are reasonably predictable. If all you had to cover was the chance of some out-of-the-blue catastrophic risk, like developing a serious cancer in your thirties, insurance would be quite cheap. But, putting it bluntly, funding healthcare is more typically about bludgeoning money out of healthy people to pay for people who need treatment. That's why the risk equalisation levy is there; its because, given the choice, most of us won't opt to pay for people who actually have heavy medical bills.

The tool that might be employed to delay a death spiral is lifetime community rating - where you penalise people who take out insurance later in life. If that doesn't work, you find people talking about the "individual mandate", which makes it compulsory for everyone to take out insurance. That's a controversial element of Obama's healthcare reform.

Personally, I think the individual mandate just locks everyone into a system that's guaranteed to facilitate ever increasing healthcare costs. There's a world bank study out there that shows tax-based systems, where you don't have competing insurers, cost less than insurance-based systems - but deliver much the same health outcomes. This is not unlike the thought you had in the OP; a single fund, or just a single healthcare purchaser funded out of tax, can provide a more efficient system.

GCU Flexible Demeanour

Nody wrote: »

Because like all types of insurance is based on investing (or in some cases speculate) the money you pay them into stocks/bonds to generate money to pay back your future claim.

That's not really relevant to private health insurance. The insurers pretty much pay out in claims what they collect in income; they do have reserves, but nothing like enough to cover the lifetime needs of their subscribers.

The premium income isn't even cover the current cost of services. The value of tax relief on health insurance was estimated to be worth over €300 million in 2009 by the Commission on Taxation, while private patients occupying public beds (as distinct from private beds in public hospitals) cost the taxpayer about another €300 million. That's €600 million in cost, over and above the €1.7 billion paid in claims by insurers. In other words, you'd need a 35% increase in premiums just to cover the cost of "private" treatment.

We need to be very clear about this. None of the insurers active in the Irish market are offering medical savings products - where you build up a pool of resources over your lifetime to meet your healthcare needs later in life. It's pretty much all on a year-to-year basis.

To be honest, its all a bit of a Ponzi. And this phrase "inter-Generational solidarity" is a complete con; what it means is "you scratch my back, and I'm sure that someone else will feel like scratching yours because I certainly won't be around to do it."

creedp

GCU Flexible Demeanour wrote: »

To be honest, its all a bit of a Ponzi. And this phrase "inter-Generational solidarity" is a complete con; what it means is "you scratch my back, and I'm sure that someone else will feel like scratching yours because I certainly won't be around to do it."

In reality if you want to implement community rating on a sustainable then health insurance has to be compulsory for the entire population. In that way premiums can be kept at a more reasonable level for all with the young healthy people contributing to the higher costs of older people. As a result, people have coverage over their lifetime and an equitable system of intergenerational subsidisation. However, this would require the Govt to get off the fence and decide to either have tax-funded system and get rid of private health insurance in publicly funded hospitals or get rid of tax funding and make private/social health insurance compulsory for all. Or in other words have one primary system of funding for public healthcare as every other civilised (except the US?) county has. The big losers of course would be the consultants so maybe that's the reason its not contemplated.

frankosw

Icepick wrote: »

public sector inefficiencies

`


Ineficient or not..public health service is largely free and its only private companies that think nothing of ramping up prices by 10% or 15%.

This is another example of greed within the private sector..i canty see how anybody can blame the PS this time.

frankosw

Icepick wrote: »

public sector inefficiencies

`


Ineficient or not..public health service is largely free and its only private companies that think nothing of ramping up prices by 10% or 15%.

This is another example of greed within the private sector..i cant see how anybody can blame the PS this time.

creedp

frankosw wrote: »

`


Ineficient or not..public health service is largely free and its only private companies that think nothing of ramping up prices by 10% or 15%.

This is another example of greed within the private sector..i canty see how anybody can blame the PS this time.

To be fair its the public hospitals that are currrently ramping up private hospital charges and this is leading to knock-on increases in premiums. These increases relate primarily to legacy subsidisation of private patients in public hospitals where private insurers were not charged and are still not charged the economic cost of providing services to their insured clients. Its easy to know these subsidies exist - why do your think insurers will cover the full cost of your care in a public hospital but only a proportion of the cost if you go to a purely private hospital/clinic? The problem is the latter charge an economic cost plus profit - otherwise they would go bust - while the public hospital only charge a proportion the cost thereby encouraging private insurers to use public hospitals. So much for the line that if people drop out of private insurance this will place an increased burden on the public hospital system! The real difference it will make is that consultant won't get paid twice and hospital won't earn private income - however, pretty much the same volume of activity will still go through the public hospital system.

Head The Wall

frankosw wrote: »

`


Ineficient or not..public health service is largely free and its only private companies that think nothing of ramping up prices by 10% or 15%.

This is another example of greed within the private sector..i cant see how anybody can blame the PS this time.

Posting twice when once would have done. That's public sector inefficiency and wastage for you

Lambsbread

An article in the IT today suggests that costs could rise more than 45% next year. Surely this is the end for VHI?

http://http://www.irishtimes.com/newspaper/frontpage/2012/1029/1224325868416.html

There is something definitely going wrong in healthcare overall (both public and private) and again it seems the cost is pushed onto the "middle class".

woodoo

If so many people are getting rid of health insurance how is that helping FG plans to get everyone on health insurance. If we aim for everyone to have private health insurance we will end up more like America than Germany.

sarumite

woodoo wrote: »

If so many people are getting rid of health insurance how is that helping FG plans to get everyone on health insurance. If we aim for everyone to have private health insurance we will end up more like America than Germany.

Health insurance alone does not make us more like America compared to Germany. There are many other aspects to the Budget to consider before simply adopting a European style healthcare system including a more wholesale tax and spending reform outside of an austerity program etc. The fact that the government struggled to get through a €100 household charge and that people are balking at the idea of general tax increases (not just for the wealthy) tells me that many Irish people are not willing to make the required adjustments necessary for a european style healthcare system.

thebman

Don't really know enough about it but I suspect VHI are scaremongering and pre-budgeting lobbying to try to make sure they aren't effected.

Try to make headlines to push public opinion against the government pushing additional costs onto VHI.

At some point health insurers are going to have to provide health insurance in this country. At the moment, it looks to me like they mostly take your money but expect the pubic hospital to care for you and pay some of the costs afterwards and still somehow make a loss on the whole thing.

Correct me if I'm wrong (I'm sure someone will :P ).

Dannyboy83

thebman wrote: »

Correct me if I'm wrong (I'm sure someone will :P ).

Well, on the price increases, I don't think it's an empty threat - they increased by 45% before:

http://www.irishtimes.com/newspaper/breaking/2011/0106/breaking32.html
Thu 01 Jan 2011
VHI to raise premiums by up to 45% next month

I think they've increased by over 100% since 2008 for some plans.

thebman

Dannyboy83 wrote: »

Well, on the price increases, I don't think it's an empty threat - they increased by 45% before:



I think they've increased by over 100% since 2008 for some plans.

Yes but they are already at the point of diminishing returns I imagine. The more they put it up, the more people leave.

I only have it as my employer pays it.

opti0nal

Lambsbread wrote: »

There is something definitely going wrong in healthcare overall (both public and private) and again it seems the cost is pushed onto the "middle class".

In a public hospital, if you have a traffic accident and they know you're going to be making a claim, they charge €1300 a night for a standard bed in a public ward. I think this is what they want to charge the health insurance companies.

There's no way a bed, some basic meals and a bit of non-intensive nursing could cost this much. Methinks there's a bit of loading going on.

thebman

opti0nal wrote: »

In a public hospital, if you have a traffic accident and they know you're going to be making a claim, they charge €1300 a night for a standard bed in a public ward. I think this is what they want to charge the health insurance companies.

There's no way a bed, some basic meals and a bit of non-intensive nursing could cost this much. Methinks there's a bit of loading going on.

There are probably more costs than that to be fair including the staff costs for one without which they can't offer you the bed.

I mean our hospitals can't stay within budget so there must be some costs there.

As for health insurance, there is little cost unless someone actually gets sick and half the things aren't covered by our health insurance like dental care which seems insane to me that dental care isn't see as part of health care.

GCU Flexible Demeanour

opti0nal wrote: »

In a public hospital, if you have a traffic accident and they know you're going to be making a claim, they charge €1300 a night for a standard bed in a public ward. I think this is what they want to charge the health insurance companies.

There's no way a bed, some basic meals and a bit of non-intensive nursing could cost this much. Methinks there's a bit of loading going on.

Not quite right; the table of charges varies according to the class of hospital and the accommodation. The current charges are here:

http://www.hse.ie/eng/services/Find_a_Service/Older_People_Services/Benefits_and_Entitlements/Hospital_charges.html#priv

The most expensive charge is €1,046 for a private room in a major hospital.

That said, because you are making a point with some validity, the same charge applies regardless of the complexity of the treatment. So if you are kept in a private room because of a relatively minor ailment, the charge is €1,046. If you're in a private room for a heart transplant, it's still €1,046 despite the greater complexity.

Now, that's not going to greatly change the overall situation for insurers; the effect of charging on the basis of an average cost does give them an incentive to use private hospitals for routine treatments and public hospitals for major surgery, but I'd say the issue at present is more a lack of transparency in the costs of individual treatments than the possibility of private insurers saving costs if the HSE had a more scientific approach to bed charging than adding up the total costs of private beds and dividing it by the number of patients.

opti0nal

GCU Flexible Demeanour wrote: »

Not quite right; the table of charges varies according to the class of hospital and the accommodation. The current charges are ....

€1300 a day was on the invoice from Beaumount for a family member who had a road accident. She was admitted via A&E and was post operative for 2 days in a ward with 5 others. The letter said that this was a 'special' rate because they knew she would be making a claim. This was just for the bed, meals and light nursing care. The operation was charged separately.

Maybe the rate has gone down since this happened?

Even €1000 a night is over the top. A room in a nice hotel with a private nurse would cost much less.

creedp

opti0nal wrote: »

€1300 a day was on the invoice from Beaumount for a family member who had a road accident. She was admitted via A&E and was post operative for 2 days in a ward with 5 others. The letter said that this was a 'special' rate because they knew she would be making a claim. This was just for the bed, meals and light nursing care. The operation was charged separately.

Maybe the rate has gone down since this happened?

Even €1000 a night is over the top. A room in a nice hotel with a private nurse would cost much less.

I think that €1,300 a day relates to the av daily cost of treatment in the hospital which is applied in the case of motor accidents. This should cover all costs including consultant costs. This is seperate to the private patient charges and I would have though should really only apply when the patient is public. If patient is private then the hospital charges the private rates for the bed etc and the consultant charges his [small!!] daily rate. In reality both charges should be reasonably equivalent but of course when you are dealing with averages reality goes out the window!

ednwireland

GCU Flexible Demeanour wrote: »

Now, that's not going to greatly change the overall situation for insurers; the effect of charging on the basis of an average cost does give them an incentive to use private hospitals for routine treatments and public hospitals for major surgery, but I'd say the issue at present is more a lack of transparency in the costs of individual treatments than the possibility of private insurers saving costs if the HSE had a more scientific approach to bed charging than adding up the total costs of private beds and dividing it by the number of patients.

i wonder if the HSE even knows what a bed night costs (from the cost of cleaners, nurses doctors etc etc) , by the way budgets seem to be decided is that they have no idea (apart from it cost x last year so we need x plus the number i first thought of)

although i think that if private health insurers want to use public hospitals then they should pay the full whack, if its cheaper for them to build their own hospitals they can. because at the moment they maybe being subdised by the taxpayer

GCU Flexible Demeanour

ednwireland wrote: »

i wonder if the HSE even knows what a bed night costs (from the cost of cleaners, nurses doctors etc etc) , by the way budgets seem to be decided is that they have no idea (apart from it cost x last year so we need x plus the number i first thought of)

Yeah, I don't disagree. I mean, I don't think insurers would save if the HSE were capable of delivering truly itemised billing. But that's really supposition on my part - I'd doubt the HSE could explain their current charges on anyone more than the most general lines.

Farmer Pudsey

The biggest issue in Ireland is that the government is in a quandry. At present people even on modest income's have health insurance. When government have imposed extra charges on these companies they loose customers and these customers fall back on the general health service. They have reached the point where the amount collected through this is below the cost of servicing the the clients that leave the health insurance companies. It biggest fear is that health insurance customers from 50 years of age on will start to fall back on the healthy service as there plans become too expensive.

Some families have even started to stop contributions to health insurance companies for there childern so as to fund there own insurance costs. This is a double edged soward as health Insurance companies are forced to increase prices to cover the loss of subsidy that the childern policy provided.

Also health costs in Ireland are excessive a doctor visit is 50 euro's, consultants are 100+ and often these are only 50% funded by Your health insurance after an excess. On top of this I notice more young parents going through the public system to have childern even though they have Health Insurance as they find the extra cost that they have to bear excess for consultant's etc.

The government must notice this in there budget figures and also the build up of resentment in the coping class which is seeing how it is again expected to pick up the cost of the rest of the population through extra charges and reduced benifits.

Dannyboy83

Well, I got my renewal quote from Laya Healthcare last night.

Up from €106.86 to €130 as of January (25% increase per month).
I'm going to downgrade.

I already have the Mrs on the bare minimum as she refuses to use Irish hospitals where possible, had a slightly better policy for myself so I'm going to downgrade that to the minimum.

Only trouble I guess is that they'll just increase the minimum policies by a similar amount next year, at which stage I might consider binning it.

Looks like we're at an impasse now with Health in this country.

jank

Just to add some details, private health insurance for a young couple in Australia will cost the bones of $3k, add another 2k if you want extras like Dental and the like. In fairness you do get good return on it as the government gives you a tax break to buy health insurance and if your income is over a certain bit you are levied an extra amount to pay for medicare. I think the system works quite well. People still complain about it of course but I think Australia has one of the best access to medical resources in the world.

There are far too many vested interests in Ireland to change it over night.

HellFireClub

sarumite wrote: »

Health insurance alone does not make us more like America compared to Germany. There are many other aspects to the Budget to consider before simply adopting a European style healthcare system including a more wholesale tax and spending reform outside of an austerity program etc. The fact that the government struggled to get through a €100 household charge and that people are balking at the idea of general tax increases (not just for the wealthy) tells me that many Irish people are not willing to make the required adjustments necessary for a european style healthcare system.

In fairness to the opposing public, many feel they have already made a very considerable contribution towards the cost of running their local authority and towards the provision of local public services, when they paid stamp duty and local authority development charges/levy's on their property. Some also feel that they are already paying for the cost of running their local authority through the collection of general tax headings such as VAT/PAYE, etc.

I imagine, just speaking for myself anyway, that people have no problem paying for a European style healthcare system, if what comes out the other end is a "European class healthcare system", but we all know the way it'll work in this country, you'll pay for it, but you'll get nothing back at the other end. It'll just be another charge that goes into the general exchequer account, to pay for only Christ knows what.

I personally would have no problem with a Household Charge or a property tax, if the money was used efficiently and fairly. Instead in this country, be it the local authorities, or the health service, wages & salaries comprise far too much an overall percentage of the total budget expenditure that is allocated to provide the service.

sarumite

HellFireClub wrote: »

In fairness to the opposing public, many feel they have already made a very considerable contribution towards the cost of running their local authority and towards the provision of local public services, when they paid stamp duty and local authority development charges/levy's on their property. Some also feel that they are already paying for the cost of running their local authority through the collection of general tax headings such as VAT/PAYE, etc.

When we had the 'tiger' we could have set up a European style healthcare system or we could give tax breaks/Pay rises/increased SW payments. We voted for the latter.

I imagine, just speaking for myself anyway, that people have no problem paying for a European style healthcare system, if what comes out the other end is a "European class healthcare system", but we all know the way it'll work in this country, you'll pay for it, but you'll get nothing back at the other end. It'll just be another charge that goes into the general exchequer account, to pay for only Christ knows what.

I personally would have no problem with a Household Charge or a property tax, if the money was used efficiently and fairly. Instead in this country, be it the local authorities, or the health service, wages & salaries comprise far too much an overall percentage of the total budget expenditure that is allocated to provide the service.

On this I agree.

Idbatterim

When we had the 'tiger' we could have set up a European style healthcare system or we could give tax breaks/Pay rises/increased SW payments. We voted for the latter.

I beg to differ, we could have had a world class funded health system and it would be still be a shambles! I saw a poll a few years ago, think it might have even been during the boom, and people at the time were asked would you be prepared to pay more tax for "better public services?" and the overwhelming answer was no, for the simple and still applicable reason, that most people feel the value for money is appalling... Of course the result wasnt surprising, far more people benefited from the tax breaks, pay rises etc and the benefits were far more instantaneous...

Mucco

I think the government is going to charge the full economic cost of health care to the private insurers. I read that Irish private insurers costs are subsidised by the public system at about 65%. You could argue that private patients are also tax payers...but that's a hell of a subsidy.

Of course, this means that PHI costs go up, which means low risk people exit the market, which means the remaining customer are, on average, more expensive, which means costs go up, ad infinitum. This is the key problem with PHI - 'adverse selection.'

HellFireClub

Idbatterim wrote: »

I beg to differ, we could have had a world class funded health system and it would be still be a shambles! I saw a poll a few years ago, think it might have even been during the boom, and people at the time were asked would you be prepared to pay more tax for "better public services?" and the overwhelming answer was no, for the simple and still applicable reason, that most people feel the value for money is appalling... Of course the result wasnt surprising, far more people benefited from the tax breaks, pay rises etc and the benefits were far more instantaneous...

Because once the money is there, or even assumed to be there, the focus comes off the project and the objective, because we then have unions who then step in and need to be paid off by way of various wage incrementing instruments, in return for their "cooperation". I mentioned before on the forum, I say this joke in motion myself in my college days when a whole lab full of computer equipment was locked away from use for a year because a departmental technician got a notion in his head that he hadn't been "consulted".

You try that in most modern private sector operations and you'll be called into a room and handed your options, which will invariably be: (1) Cooperate wholeheartedly, or (2) Leave.

This resistance to change, which is behind the problems in the health service, is simply a disease within Irish society, even now, 4 years into this, Croke Park is still unable to remove it and put a new game in place...

maninasia

GCU Flexible Demeanour wrote: »

Oh, yes, you are right there. Ultimately, and over time, there absolutely is a risk of what's termed a death spiral - where the only people left in the pool are high risks, which makes it pointless to take out insurance as the cost will start to rival what it would cost to just pay directly for the medical care.

The problem is health risks are reasonably predictable. If all you had to cover was the chance of some out-of-the-blue catastrophic risk, like developing a serious cancer in your thirties, insurance would be quite cheap. But, putting it bluntly, funding healthcare is more typically about bludgeoning money out of healthy people to pay for people who need treatment. That's why the risk equalisation levy is there; its because, given the choice, most of us won't opt to pay for people who actually have heavy medical bills.

The tool that might be employed to delay a death spiral is lifetime community rating - where you penalise people who take out insurance later in life. If that doesn't work, you find people talking about the "individual mandate", which makes it compulsory for everyone to take out insurance. That's a controversial element of Obama's healthcare reform.

Personally, I think the individual mandate just locks everyone into a system that's guaranteed to facilitate ever increasing healthcare costs. There's a world bank study out there that shows tax-based systems, where you don't have competing insurers, cost less than insurance-based systems - but deliver much the same health outcomes. This is not unlike the thought you had in the OP; a single fund, or just a single healthcare purchaser funded out of tax, can provide a more efficient system.

Insurance companies are unneccessary middlemen who bump up premiums without providing a better service. Who provides the service, not the insurance company but the hospitals and their staff? Who operates the hospitals, the government using taxpayer money along with some private hospitals.

A single mandatory contribution national insurance fund run by a government agency keeps costs down by getting rid of the middleman. In this system you are valued more, as the money follows you through the system according to which hospital you visit or which procedure you undergo.

You can choose which hospital to go to, whether public or private, you can shop around, and hospitals compete for you, their client. They need to up their game, and give a better service, at the same time you pay less money and get better coverage.

This system also encourages investment in private hospitals, as it guarantees a broad and deep potential client base. Private hospitals can then offer an alternative to the local existing public hospital for some services, or they can specialise in niche areas and they can reduce costs due to their privatized operations. They can offer a modern alternative in areas where a public hospital would simply not be feasible to build or maintain due to higher costs. To the patient (client) it doesn't matter if the hospital is public or private, all that matters is you are satisfied with the service.

Waiting list in one hospital? Go to another with no waiting list. Not satisfied with service or medical competence in one place, go somewhere else. You are the client and you paid for it all...through your tax contributions. It's a complete reversal of the way the system works in Ireland, where you become a beggar or somebody to extract more money from in order to skip the queue.

Such systems are in operation already worldwide, they may have some minor flaws, but they are far superior to the models where insurance companies get their claws in.

sock puppet

maninasia wrote: »

Insurance companies are unneccessary middlemen who bump up premiums without providing a better service. Who provides the service, not the insurance company but the hospitals and their staff? Who operates the hospitals, the government using taxpayer money along with some private hospitals.

A single mandatory contribution national insurance fund run by a government agency keeps costs down by getting rid of the middleman. In this system you are valued more, as the money follows you through the system according to which hospital you visit or which procedure you undergo.

Yeah, lets get rid of the middlemen by putting in another middleman.

maninasia

I don't think you get it, the 'middleman' in terms of the government already exists. If you want to get rid of that then close down all the public hospitals.
The system above encourages investment in private hospitals and competition between hospitals.
Sure in theory you could just pay directly to private hospitals, but the idea of a national health insurance system is that covers rich and poor.