Health Insurance

Quitelife

https://www.boards.ie/discussion/comment/120094594#Comment_120094594

I dont mind paying pensions of working people who reach the age of 66 but its the Public Sectoe DB pensions that are the bigger cost , especially for the layers and layers of Management in the HSE which are not needed.

What % of the spend on HSE goes towards wages compared to the % of the Dutch or Belgium health systems which are very well run but they dont have heaps & heaps of very well paid middle management layers taking up all the money.

Breezy_

https://www.boards.ie/discussion/comment/120120715#Comment_120120715

thats a huge figure. out of the reach of most.

beaufoy

On the understanding I have hemeroids , and the insurance company sent me for a medical which found blood in the stool, and the doctors report stated blood came from a hemeroid and there is no need for a another stool test or any other examination .....can the insurance company ignore the doctor's advice and insist on a colonoscopy

Peregrinus

https://www.boards.ie/discussion/comment/121886560#Comment_121886560

You mean, can they force you to go for a colonoscopy when you don't want to? No, nobody can oblige you to accept unwanted medical treatment.

Peregrinus

https://www.boards.ie/discussion/comment/120123470#Comment_120123470

Ireland: HSE spending on pay and pensions makes up 33.3% of their total expenditure. 21% goes to clinical staff, 4.9% to other client/patient services (whatever that means) and 7.4% goes to non-clinical staff. (Figures from 2022.)

Netherlands: 69% of total public health expenditure goes on salaries. (Figure from 2020.) I don't have a breakdown between clinical, non-clinical, etc.

Belgium: I have no data.

Note that HSE spending in Ireland and total public health expenditure in the Netherland are not directly comparable; there may be health spending in Ireland that is not HSE spending. Still, there's nothing here at first glance to support the view that the HSE is top-heavy with middle managers by comparison with the Netherlands.

beaufoy

https://www.boards.ie/discussion/comment/121886589#Comment_121886589

no they cannot force me to have a colonoscopy which they do not dispute is painful and can do damage to your body. However they can put restrictions on the policy which will prevent claims with even the slightest relation to the bowels

Peregrinus

Yes. Their position — and you can see the point — is that they pay the cost of your medical treatment, and it will cost them much less if your medical conditions are investigated, diagnosed and treated at an early stage than if they are not investigated, allowed to develop, and only treated when they are much further advanced. So the quid-pro-quo for "we bear the financial risk of your serious ill-health" is "you engage with preventative, screening, diagnostic procedures so as to reduce the risk of serious ill-health".

But I think the argument against that is that this should be a clinical decision. There's a risk to not having this or that diagnostic procedure, but there's also a (different) risk to having it. Balancing these risks is something you should do with the advice of your doctor, and the decision should be made first and foremost on health grounds, not on financial grounds.

I think a dispute of this kind (Can my insurer restrict my cover if I decline to undergo medical procedures that I don't want and that my doctor agrees are not clinically indicated?) is something you can take up with the Financial Service and Pensions Ombudsman, or possibly with the Health Insurance Ombudsman. Maybe approach one of those; if they think you should approach the other one they'll tell you so.

tomhammer..

What are health insurance cos. like with exclusions for older persons

If you want to take out a policy will they exclude everything related to past health issues

witchgirl26

https://www.boards.ie/discussion/comment/121887396#Comment_121887396

There'll usually be exclusion periods for everyone if they've had a break in health insurance cover for pre-existing conditions. Depending on the nature it might be 6 months, could be a year or even more. Basically they don't want someone taking out a policy, knowing they have a condition & using a lot of the insurers money to cover that when they've hardly been a customer. It's understandable.

That said, if there's been no break in cover of insurance (i.e. you're just moving between 2 companies) then there's no exclusion/wait period. There's also a charge now depending on age if you've not had health insurance before - it's 2% per year after the age of 34.

beaufoy

https://www.boards.ie/discussion/comment/121886980#Comment_121886980

I believe you are being kind to the insurance company in that you believe that the insurance company might be doing their policy holders a service by taking a decision which is reserved for doctors to take....do you agree with the insurance company that anyone over 65 years with bleeding hemeroids should be made to have a colonoscopy. Do you understand the insurance company is not interested in keeping their clients healthy. Therefore (with your permission ) the insurance company could act in the opposite direction. If a doctor decides that a heart by pass is required the insurance company could say ( we know what is best for the patient) we do not agree with the doctor we have decided medication is the best way to treat the heart condition because a by pass could be dangerous for people over 65

Peregrinus

I'm not trying to be kind to the insurance company. If you're going to follow up the avenues I have suggested for complaining about your insurer's demands, it's not enough for you to be angry about those demands; you need to understand why the insurance company is making them so that you can argue they are unjustified. To understand what the insurance company is doing here we have to try to see things as they see them. But that doesn't mean I agree with how they see them.

If health insurance is to serve a socially useful function, we have to arrange matters so that the outcome that is good for the insurer (i.e. the outcome that maximises the insurer's profits) is also the outcome that is good for society (i.e. people are generally as healthy and well as they can be). It's very easy to design - by accident - a health insurance system in which, the more money is spent on healthcare, the more profits the insurance company makes. So the sicker people get, the more treatments and procedures they require, the better insurance companies do. That's a vicious circle that we should avoid, if possible.

Hence a trend in recent years to regulate insurance companies in a way that means they do best financially, not by paying out when people get sick, but by keeping them well. So, a big emphasis on screening, diagnostic procedures, identifying and managing risk, etc. And I suspect that's the context within which they are demanding that that you should have a colonoscopy.

There are two different lines that you could take to resist this. One is to argue for patient autonomy — what treatment or diagnostic procedures you should have, balancing the risk of having the procedure against the risk of not having it, etc, is a matter for the patient, informed by the advance of their doctors and other medical professions. The patient is entitled to make these decisions and, even if they make decisions which the insurer considers to be not the best decisions, the insurer should not be entitled to interfere. The insurer just has to wear this risk and price it into the premiums they charge.

The other is to argue that the insurer has got it wrong in this case. Your risk of bowel disease is low, and your doctors advise that a colonoscopy is not clinically indicated in your case. There are clinical risks involved in having a colonoscopy, and your judgment, and the judgment of your doctors, is that in your case the possible benefits that might result from a colonoscopy do not outweigh the risks and stress of having one. The insurer is mistaken in thinking that requiring a colonoscopy maximises the chances of you being kept healthy.

Quitelife

https://www.boards.ie/discussion/comment/120091783#Comment_120091783

do you mind me asking it says on my Vhi policy they cover 90% of orthopaedic stuff like a new hip ??, reading this I guess I’ve to pay 10% of cost … have you heard of this ..

MIKEKC

https://www.boards.ie/discussion/comment/121912562#Comment_121912562

Yes this change was made to these policies about three years ago. Not only VHI but Lays also. 20% with Laya. Conor Pope was on TV 3 warning about it at the time.What annoyed me about it was the fact that it was not pointed out at renewal. People need to read the policy before renewing but many dont. I feel that it a change is made to a policy a separate letter should be sent pointing this out.

https://www.boards.ie/discussion/comment/121912562#Comment_121912562

I can advise on this from experience. Had left knee replace in the Beacon, was advised by VHI they only cover 90% but that I could negotiate with the hospital, which I did, and they waived the 10%.

Re colonoscopy for bleeding Hemorrhoids, the risk of bowel cancer rises as we get older, and in most cases would outweigh the risk of a colonoscopy opt. I’ve had about 25 colonoscopies before having my colectomy for colitis, never a complication. Nowadays ordinary uncomplicated resection bowel cancer surgeries are done keyhole and recovery is normally very quick. A colonoscopy is, in most cases, are far more likely to be life-saving than life-threatening.

Shauna677

https://www.boards.ie/discussion/comment/121912562#Comment_121912562

Alot of them are charging 20% copayments now on alot of the policies for such things as hip and knee replacments. It would mean forking out 5k + on a hip replacment. I think they doing this to get round the community rating as its mainly the elderly that require these types of surgery.

MIKEKC

https://www.boards.ie/discussion/comment/121923637#Comment_121923637

Laya, introduced this about three years ago. You can change your policy to bring your cover back to 100%.It costs about e200. a couple. VHI. did something similar. Did you get your figure of 5k from an insurer? Pure nonsense I believe

Shauna677

https://www.boards.ie/discussion/comment/121923920#Comment_121923920

Yes, i already have the cover but for those who dont, its a significant bump in the premium payable and the two year upgrade rule applies.

MIKEKC

https://www.boards.ie/discussion/comment/121924649#Comment_121924649

Yes it is a significant bump.If you already had this cover you could upgrade to the new policy at renewal without the two year rule applying.This happened to me .I immediately upgraded.

mariaalice

Our policy had a hefty increase of around 15% VHI so they are obvesiouley trying to get rid of that plan, your head would be melted comparing plans though.

The claim for GP visits seems to be what they want to get rid and some of the cover for consultant's visite On the other hand The Beacon Hospital seems to have become fully covered in a lot of the plans.