Health insurance hikes and Irish Government

Bullseye1

Looks like those of us with PHI can look forward to 30-40% price hikes this year. What is governments end game here? We can expect huge numbers to drop their insurance and rely on the public health system. Is this what they want?

http://www.independent.ie/business/personal-finance/government-plans-for-patients-could-hike-health-insurance-premiums-by-40pc-say-firms-29086359.html

I think after this years premium is up that will be it for me.

squod

Literally shed loads of unlisted corporate plans to choose from. Think renewals will cost less this year because of these plans.


PMI 32 12 from VHI is (I think) €300 cheaper than it's ''listed'' corporate or private plan equivalent .

http://www.lfs.ie/vhi-to-release-new-pmi-32-12-plan-on-01.10.2012.asp

Private Joker

and folks you can ask for any plan you want, you can get the nurses plan even if you're not a nurse, or the intel plan even if you don't work for intel.

Geuze

Bullseye1 wrote: »

Looks like those of us with PHI can look forward to 30-40% price hikes this year. What is governments end game here? We can expect huge numbers to drop their insurance and rely on the public health system. Is this what they want?

I think after this years premium is up that will be it for me.

The irony is that the current "end-game" is UHI, universal compulsory health insurance.

The money will follow the patient.

The plan is that from 2016 everybody will have health insurance.

The public/private patient split will be gone, hopefully.

You will be a patient, full stop.

Every hosp should accept every patient, as every patient will have insurance.

BKtje

Wouldn't it depend on the system put into place? There may be various plans with the cheapest locking you into your local hospital/region (except in an emergency). You would then pay extra to be able to choose a lower deductable, hospital of your choice, semi private/private rooms, dental etc etc. Basically the lowest "plan" allows you access to your nearest hospital and your premiums are calculated for that hospital.

If we all have private health insurance then the state sets the minimum care that insurance companies need to pay and anything extra costs, well, extra. That's where the companies would make their profits. Not saying that that's the way it would go but that's how it works in some countries.

GCU Flexible Demeanour

http://www.independent.ie/business/personal-finance/government-plans-for-patients-could-hike-health-insurance-premiums-by-40pc-say-firms-29086359.html

GOVERNMENT plans to begin charging insured patients in public beds will add 20pc to 40pc to the cost of health insurance premiums, it was claimed today.

|Does this mean that the State is already covering up to 40% of the costs of 'private' medicine? Ludicrous situation, that should never have been allowed.

creedp

GCU Flexible Demeanour wrote: »

|Does this mean that the State is already covering up to 40% of the costs of 'private' medicine? Ludicrous situation, that should never have been allowed.

Well it seems that as much as half of all private patients in public hospitals beds end up public beds and therefore cannot be charged for private accommodation. Given that the major hospitals charge over €1k a day for a private bed, the subsidy is pretty substantial. The problem for me is that if this goes ahead there will be a massive financial incentive for hospitals to put private patients in public beds so as to generate addititional private income. That's bad news for the public patient and could lead to even increased public waiting lists.

Course the Govt come come along and use the additional income to buy services for public patients in private hospitals ... hey we are back where we started! Maybe the logical reform is to limit the number of private patients who can be treated privately by their consultants in public hospitals thereby forcing them to use private hosptals instead. Given that we constantly hear about the uber efficient private hospitals system .. surely its a win win situation!

GCU Flexible Demeanour

creedp wrote: »

<...> if this goes ahead there will be a massive financial incentive for hospitals to put private patients in public beds so as to generate addititional private income.

I'd agree that's a risk - one of the reason for the present arrangment was to avoid giving hospitals a finanical incentive to put a private patient in a public bed. At the same time, I suppose we have to be realistic in acknowledging that this hasn't been effective.

Also, I think we have to examine the practical effect of what's envisaged. The Budget 2013 measure is

http://www.imt.ie/features-opinion/2012/12/new-cut-in-gp-fees-following-budget.html

increased generation of private income in public hospitals (€65 million)

Now, VHI alone has income of about €1.3 billion. Even if VHI has to cover all of that cost (and it probabaly does have to cover 75 or 80% of it), and even if risk equalisation didn't exist, it would only involve an increase of perhaps 5%.

I know there's been a recent bunfight in the papers between VHI and the Department of Health over precisely how effectively risk equalisation is in spreading these cost. However, the one thing that's quite clear is the nonsense in talk of 20% to 40% increases occuring in 2013 as a result of this one measue.

antoobrien

GCU Flexible Demeanour wrote: »

|Does this mean that the State is already covering up to 40% of the costs of 'private' medicine? Ludicrous situation, that should never have been allowed.

No, they (VHI, Laya, Aviva et al.) were being charged the public rate instead of the private rate for these beds as it was the actual price of the bed being used. Now it seems that the pricing scheme is being changed to reflect the fact that the bed is really private.

creedp

antoobrien wrote: »

No, they (VHI, Laya, Aviva et al.) were being charged the public rate instead of the private rate for these beds as it was the actual price of the bed being used. Now it seems that the pricing scheme is being changed to reflect the fact that the bed is really private.

The public rate is €75 per night up to a max of €750 (10 days) in a 12 months period. This does not reflect the cost of any bed but is simply the equivalent contribution non medical card holders make when recieving services in a public hospital. Private patients pay both the €75 per day and the going private rate which in a semi-private ward would be approx €800k per day.

The problem with the current system is that hospitals can only charge the private rate if patient is in a privately designated bed (about 20% of all beds) and hospitals are not allowed put a private patient in a public bed if they are planned admissions. What's the solution - come in via A&E and the hospital has to put you into whatever bed is available -if no private bed then they will be put into a public one. The only consistent fact is that the Consultant gets paid privately irrespective of the bed category.

Now they are proposing to change legislation so when a patient is private to consultant they get charged a private rate irrespective of the bed category occupied. I would like to see some form of restriction whereby if no private bed available then patient can't be private to their consultant and therefore consultant couldn't charge a private fee. This would remove the incentive for consultant to prioritise access for private patients. Doubt that could happen in the real worls however.

GCU Flexible Demeanour

I'd say the only point to add is that it's hard to account for 50% of private patients ending up in public beds, simply because of admission coming from A&E. I know there's a second turn of the explanation presented, to the effect that a public patient with an infectious condition would need a single room - or similar scenarios. I might find this explanation more credible if the Black Death stalked the land. I'd feel the high proportion of non-chargeable private patients suggests some structural problem, and the (rather overblown) reactio of insurers suggests that they;ve built their business models around the idea that they wouldn't have to meet the full bed charge for half their subscribers using public hospitals.

creedp

GCU Flexible Demeanour wrote: »

I'd say the only point to add is that it's hard to account for 50% of private patients ending up in public beds, simply because of admission coming from A&E. I know there's a second turn of the explanation presented, to the effect that a public patient with an infectious condition would need a single room - or similar scenarios. I might find this explanation more credible if the Black Death stalked the land. I'd feel the high proportion of non-chargeable private patients suggests some structural problem, and the (rather overblown) reactio of insurers suggests that they;ve built their business models around the idea that they wouldn't have to meet the full bed charge for half their subscribers using public hospitals.

Agree on the infectious disease issue - its kind of a crazy system that doesn't have any single occupancy rooms set aside for public patients - all are designated private - that just shows how incoherent the whole public hospital system is at present.

beeno67

GCU Flexible Demeanour wrote: »

I'd say the only point to add is that it's hard to account for 50% of private patients ending up in public beds, simply because of admission coming from A&E. I know there's a second turn of the explanation presented, to the effect that a public patient with an infectious condition would need a single room - or similar scenarios. I might find this explanation more credible if the Black Death stalked the land. I'd feel the high proportion of non-chargeable private patients suggests some structural problem, and the (rather overblown) reactio of insurers suggests that they;ve built their business models around the idea that they wouldn't have to meet the full bed charge for half their subscribers using public hospitals.

But why should the patient have to pay (through increased health insurance costs and possibly through the excess on their health insurance ). If two people go to hospital, both with identical jobs, income, etc with exactly the same illness, in public beds, why should one have to pay more simply because he took out health insurance?

creedp

beeno67 wrote: »

But why should the patient have to pay (through increased health insurance costs and possibly through the excess on their health insurance ). If two people go to hospital, both with identical jobs, income, etc with exactly the same illness, in public beds, why should one have to pay more simply because he took out health insurance?

The more pertinent Q is why should 2 patients of equal clinical need be treated differently in terms of accesssing a bed in a public hospital simply because one pays €250 per outpatient session to a private consultant. Having private insurance means you get preferential access to a public hospital even if a public patient has a greater clinical need for that care.

However there is no problem if the guy who decided to pay for PHI accesses a private hospital in a timely basis. He pays hs insurance premium and he gets his private service. Its still not a optimum situation from a societal perspective that access to services is based on ability to pay but thats the way the world works .. money talks

beeno67

creedp wrote: »

The more pertinent Q is why should 2 patients of equal clinical need be treated differently in terms of accesssing a bed in a public hospital simply because one pays €250 per outpatient session to a private consultant. Having private insurance means you get preferential access to a public hospital even if a public patient has a greater clinical need for that care.

That in fairness is a different argument. These days, with bed shortages, elective admissions are rare especially in bigger hospitals.

creedp

beeno67 wrote: »

That in fairness is a different argument. These days, with bed shortages, elective admissions are rare especially in bigger hospitals.

Dont forget the majority of activity in public hospitals now relates to day cases which are wholly elective.

If you want some information on hospital activity have a look at this tome!!

http://www.esri.ie/__uuid/462574ea-80a8-4bb4-96ea-31bf0fdcfc2d/2011-HIPE-Annual-Report-Final.pdf

beeno67

creedp wrote: »

Dont forget the majority of activity in public hospitals now relates to day cases which are wholly elective.

If you want some information on hospital activity have a look at this tome!!

http://www.esri.ie/__uuid/462574ea-80a8-4bb4-96ea-31bf0fdcfc2d/2011-HIPE-Annual-Report-Final.pdf

Again day care admissions are different. Patients with health insurance already pay for daycare admissions. In addition patients with health insurance already pay for hospital admissions to private rooms or to semi private rooms.
The question is why should people who declare they have health insurance, be expected to pay more for a public bed than someone of equal illness and income who has no insurance. That is the part that is unfair.

creedp

beeno67 wrote: »

Again day care admissions are different. Patients with health insurance already pay for daycare admissions. In addition patients with health insurance already pay for hospital admissions to private rooms or to semi private rooms.
The question is why should people who declare they have health insurance, be expected to pay more for a public bed than someone of equal illness and income who has no insurance. That is the part that is unfair.

Why are they different? Private patient already pay for in-patient services in exactly the same way. The only difference between day-case and in-patient is that a day-case doesn't stay in overnight and pay about 80% of the rate applicable to thedaily in-patient rate. You can't be admitted as a day case unless you first attend your consultant. If you pay your consultant privately you can see him up to a year before a public patient will see him. That means you will get into the public hospital a year ahead of a public patient. This is why private patients have preferential access to public hospitals and is the primary reason why people retain private health insurance.

I agree they pay their insurance premium and because of that there is no problem if private patients access private hospitals.