Health Insurance

Mucco

tony81 wrote: »

Leave people with more money to pay more of their own bills, and to take out their own health insurance policies in a free health insurance market. It's the only way to drive costs down.

As others have pointed out, this is similar to the US system. They pay ~20% of GDP on healthcare yet have the same outcomes as other countries.
Free-market insurance fails for number of reasons, mostly due to asymmetric info.
The customer knows their health risk, the insurer doesn't. This leads to adverse selection: unhealthy people buy insurance, healthy don't. This skews the risk profile, leading to higher premiums, leading to moderately healthy exiting the market, leading to even more skewed risk profile etc... Described by Akerlof
The usual solution is to make insurance compulsory, as in most OECD countries, leading to low risk subsidising high risk.
Another solution is to have accurate health assessment to establish the true risk, and premium, as in the US. This leads to high risk people unable to afford insurance, plus is costly. 31% of US healthcare costs are for admin.
A linked problem is that if an insured person develops a health condition, they cannot move insurer as their premium would rocket. Not much of a free market!

Geuze

ted1 wrote: »

This doesn't make sense. As a PRSI payee I am entitled to healthcare, if I decide to top it up with private healthcare then I should be entitled to use the contribution I pay to PRSI.

If the proposal is to remove entitlement to the Public hospital well then I would expect to opt out of PRSI.

Or else I'll cancel my insurance and become another burden on the public system

PRSI has very little to do with health, it just covers dental and optical exams.

In Ireland, healthcare is mainly tax financed.

Geuze

ted1 wrote: »

This doesn't make sense. As a PRSI payee I am entitled to healthcare, if "


Incorrect.

All residents of Ireland are entitled to healthcare, since the 1970 Health Act.

Nothing to do with PRSI.

creedp

ted1 wrote: »

This doesn't make sense. As a PRSI payee I am entitled to healthcare, if I decide to top it up with private healthcare then I should be entitled to use the contribution I pay to PRSI.

If the proposal is to remove entitlement to the Public hospital well then I would expect to opt out of PRSI.

Or else I'll cancel my insurance and become another burden on the public system

If you cancel your insurance and become a burden on the public system its the poor consultants who earn a public salary and private fees when working in a public hospital who stand to lose most. Thats the problem in Ireland people who dont want to be a burden on the public system should actually go to a private hospital and be treated by a consultant who earns private fees only.

rodento

Over 200,000 thousand young folk have cancelled there insurance

http://www.independent.ie/national-news/health-insurance-crisis-as-200000-drop-their-cover-3358000.html

creedp

rodento wrote: »

Over 200,000 thousand young folk have cancelled there insurance

http://www.independent.ie/national-news/health-insurance-crisis-as-200000-drop-their-cover-3358000.html

This is no surprise .. you cant have community rating and life long cover unless you have compulsory sign up for health insurance for theyoung and healthy. The Irish system is a failed entity and will keep gorging on itself until it collapses. The real issue is why do we have a system which everybody is compulsorily insured through the tax system and yet we have a little under 50% of the population [and dropping] privately insured for pretty much the same health risks. Bloody mad system and the sooner it collapses and we are forced to reform this aspect of the Irish health system the better!

Jedi Knight

Are there any private health companies people could recommend on this thread?

Single 32 year old here. Cheers.

mahamageehad

As it stands, I don't see the purpose of paying for health insurance in Ireland. Now maybe I'm missing something but I looked into getting health insurance a few months back and it seemed to me to simply be paying for the possibility of something happening. The premium I'd be paying simply works out as more expensive than what I'd pay in healthcare in a year. Quite frankly for me to pay that much for health insurance I would then expect to pay nothing else for it.

I didn't mind paying health insurance when I lived in Germany as after you've paid then GP visits, gynecologist, optician, dentist, hospital care etc are free. All I had to pay was a €10 quarterly charge to my GP office and the price of any medication. As I understand the policies here I'd have to pay the GP fees etc and if I hit so many visits in a month/year I can claim back some (but not all) of the money I paid. Now I am open to correction on that. Where is the incentive for a young woman with no current healthcare issues to get insurance? We are already paying through the teeth for everything in this country- the PRSI used to cover optician and dentist check ups but as far as I know they don't even do that anymore.

shedweller

^^^^^^^^^^
Apple Cart. Don't rock it.

bbsrs

Jedi Knight wrote: »

Are there any private health companies people could recommend on this thread?

Single 32 year old here. Cheers.

Check through them yourself , they're basically all the same level of cover depends on how large a premium you are willing to pay.
This link is very good for comparing policies .
http://www.hia.ie/ .

carpejugulum

Private health insurance should be modelled by car insurance, so your past usage and present circumstances matter.

creedp

carpejugulum wrote: »

Private health insurance should be modelled by car insurance, so your past usage and present circumstances matter.

True private health insurance is modelled in that way .. what we have in Ireland is not private health insurance but a State regulated insurance system providing in the main to subsidise priority access to public hospitals for older and sicker people. Without the subsidy these people could not afford insurance and the older they got the less they could afford it.

It we want to have a sustainable private health insurance system in this country with community rating and lifetime cover, then the full population must be compulsorily covered, e.g. employed persons are obliged to take out a private health insurance policy and then the premiums paid by younger, healthier people are higher that they would pay in a purely private system but this premium subsidises the higher costs of older, sicker people alling the system to survive with premiums which are more affordable for all. It just so happens the insurance is provided by private health insurance companies.

maninasia

Universal health insurance systems have proven to give the best coverage and more equitable coverage across the working and non working population.

Head The Wall

Old people don't seem to concerned about the extortionate motor insurance young people have to pay but then they are also expected to stump up for higher risk peoples health insurance.

Community rating sucks

creedp

Head The Wall wrote: »

Old people don't seem to concerned about the extortionate motor insurance young people have to pay but then they are also expected to stump up for higher risk peoples health insurance.

Community rating sucks

Yes it pretty much sucks in Ireland because as you say younger people are greatly subsiding the right of older sicker peope to gain preferential access to public hospitals. The latter already have the right to access these services funded by their taxes. However, I think though the worst element is that the older subsidised people could have taken out insurance late in life and so never had to pay the inflated premiums as younger people but now expect younger people to subsidise their premiums because it benefits them to have insurance. Such a system is inherently unfair and doomed to failure.

kippy

Head The Wall wrote: »

Old people don't seem to concerned about the extortionate motor insurance young people have to pay but then they are also expected to stump up for higher risk peoples health insurance.

Community rating sucks

Would you rather be old?

Peanut2011

That is why I can see the whole private healthcare system failing in the future. The government levies and increasing prices in Ireland are forcing people to cancel their covers as they simply can not pay any longer. The generations who are subsidizing the older population are cancelling and it won't be too much longer before the balance is so far off that the companies will have no choice but to either close / pull out of the market or increase the pricing so much that no one will be able to afford it.

The whole private health care should have been looked at during the boom years and not now when the healthcare system is so over burdened that these new changes are only driving people in to a public care.

AlexisM

An 'age at entry' system of rating policies would be much fairer and would encourage younger. healthier people to join/stay. So a person joining at age 64 could be charged a lot more than a person who has been in since birth or age 20 etc. The idea is mooted every now and then but I don't know why the idea is never run with - makes so much sense - join early and be sure of reasonable rates for life (subsidise others when you are healthy, be subsidised yourself when you are older); join late and take your chances of 'old joiner' rates being high.

Head The Wall

kippy wrote: »

Would you rather be old?

We all will be at some stage, I'm middle aged by the way.

My point is that in both motor and health insurance its the younger people that get fupped each time whether they are classed as high risk or not.

I haven't had health insurance since I came of my parents at 16 and its not something I'm bothered about either

kippy

Head The Wall wrote: »

We all will be at some stage, I'm middle aged by the way.

My point is that in both motor and health insurance its the younger people that get fupped each time whether they are classed as high risk or not.

I haven't had health insurance since I came of my parents at 16 and its not something I'm bothered about either

Whats the problem then if we will all be old someday?

creedp

kippy wrote: »

Whats the problem then if we will all be old someday?

The point is if we all wait until we are old to take out private health insurance most of us wouldn't be able to afford it! Its only because there still remains an adequate number of younger cheaper policy holders that subsidise older policy holder premiums that the system survives. Unfortunately for older people this won't exist for too much longer. So its the older people who will lose out most if young people give up their insurance or at least that is what people claim.

GCU Flexible Demeanour

creedp wrote: »

So its the older people who will lose out most if young people give up their insurance or at least that is what people claim.

Although, I think we should consider how long it would take such issues to matter. Over 40% of the population still have private cover. If that dropped to 30%, it would still be a substantial pool. That pool would very likely be older; but the kind of older people who have health insurance are more likely to be financially secure and less likely to have incomes that could be hit by redundancy, or be facing a debt burden.

I think the private health insurance market could shrink quite a bit before we'd be facing any worries about old people losing cover, or substantial costs hitting the public system.

creedp

GCU Flexible Demeanour wrote: »

Although, I think we should consider how long it would take such issues to matter. Over 40% of the population still have private cover. If that dropped to 30%, it would still be a substantial pool. That pool would very likely be older; but the kind of older people who have health insurance are more likely to be financially secure and less likely to have incomes that could be hit by redundancy, or be facing a debt burden.

I think the private health insurance market could shrink quite a bit before we'd be facing any worries about old people losing cover, or substantial costs hitting the public system.

The problem is however is the tipping point where young healthy people who have high cost of living with mortgages, children, travel to work, etc will no longer want to pay the highly inflated premiums is probably not too far away. When it is reached then a large proportion of these younger people could leave resulting in very significant premium increases for those remaining. At present the Govt is scared to do anything that will annoy old people .. for crying out loud pensioners earning €600 (single)/€1,200 (couple) gross per week are treated as vulnerable financially and give a medical card. So what will they do if this further significant increase will happen?

With regards to substantial costs hitting the public health sector from people giving up health insurance it is worth noting that health insurance contributes in the region of €400m a year to the public hospital system. So even if that reduced by 50% this would amount to a €200m burden. Put this in the context of the €780m cut backs being introduced in 2013 alone.

It is also likely the people who will give up insurance are not those who would use private hospitals so the majority of them are currently being treated in public hospitals already. Because of this if they give up insurance and revert to the public health system this will not add a whole lot of additional capacity burden on the public hospitals, i.e. they will still be treated in the same hospitals by the same clinicians/equipment/theatres/etc.

Because of this is we want private insurance to survive we would be better off having a lower number of privately insured but require them to be treated in private hospitals/facilities, i.e. a true private health system.

GCU Flexible Demeanour

creedp wrote: »

With regards to substantial costs hitting the public health sector from people giving up health insurance it is worth noting that health insurance contributes in the region of €400m a year to the public hospital system. So even if that reduced by 50% this would amount to a €200m burden.

I think there's a few balancing factors that have to be kept in mind. Firstly, the folk dropping cover are not likely to be the ones who claim. They're likely to be the younger folk, who rarely seek treatment. Also, recall that the Comptroller and Auditor General found that half of private patients are seen in public beds - placing a cost of a few hundred million on the public service. Plus, tax relief adds another cost of a few hundred million on the public purse. Between those two things, the taxpayer is shelling out something of the order of €600 million in public subsidy to get that €400 million in private income.

Now, I do take your point that if the private system vanished overnight, we could well have much the same patients turning up to be seen in much the same hospitals by much the same doctors. I'd just feel that the logic of public subsidy for private insurance doesn't stack.

creedp wrote: »

Because of this is we want private insurance to survive we would be better off having a lower number of privately insured but require them to be treated in private hospitals/facilities, i.e. a true private health system.

I'd basically agree with that, and I wouldn't see a sudden elimination of public subsidy as feasible. However, it would strike me as sensible if the policy was to phase out public subsidies over a few years, with the ultimate destination being the cessation of private work in public hospitals.

creedp

GCU Flexible Demeanour wrote: »

I think there's a few balancing factors that have to be kept in mind. Firstly, the folk dropping cover are not likely to be the ones who claim. They're likely to be the younger folk, who rarely seek treatment. Also, recall that the Comptroller and Auditor General found that half of private patients are seen in public beds - placing a cost of a few hundred million on the public service. Plus, tax relief adds another cost of a few hundred million on the public purse. Between those two things, the taxpayer is shelling out something of the order of €600 million in public subsidy to get that €400 million in private income.

Now, I do take your point that if the private system vanished overnight, we could well have much the same patients turning up to be seen in much the same hospitals by much the same doctors. I'd just feel that the logic of public subsidy for private insurance doesn't stack. I'd basically agree with that, and I wouldn't see a sudden elimination of public subsidy as feasible. However, it would strike me as sensible if the policy was to phase out public subsidies over a few years, with the ultimate destination being the cessation of private work in public hospitals.

I agree with you - there shouldn't be a public subsidy for private services in public hospitals, but I would go one step further and say there shouldn't be a private service in public hospitals full stop. It create perverse incentives for hospitals (to maximise income), for clinicians (to prioritise access to public hospitals in order to maximise income), for insurers (who currently design their policies such that there is no top-up charges if you use a public hospital but there are if you opt for a private hospital) and patient who will will opt for a public hospital to avoid top up charges.

The outcome of the current system is that public patients is public hospital are severely discriminated against in terms of accessing services even if they have a greater clinical need for care.

In relation to €600m subsidy to earn €400m, it looks like the Minister is intending to close that gap on a phased basis but that still means the public patient is disadvantaged in access terms. Furthermore, it is difficult to see how consultants in public hospitals can direct the same level of care towards their public patients as their private ones given the perverse income issue. In other words not only are the public patients disadvantaged in terms of access but also in terms of quality of care. This issue cannot be resolved by narrowing the subsidy. Lastly, the €400m in income only relates to in-patient services and not to outpatient services. Private consultants can refer their fee paying patients to public out-patient clinics for diagnostice, etc at no charge to anyone but the taxpayer. This is another hidden subsidy that is not being addressed. In my view if a private consultant refers patients to public hospital outpatient clinics, it is the consultant that should be charged for the use of public facilities/staff and he can pass this onto his patient.

However, at the end of the day public health services are funded by taxes and all residents should have equal access to quality public health services based on clinical need. If people want to opt for something else then they should pay the risk adjusted premium to receive this care in the private sector. The tax credit on premiums could still remain to encourage better off people to pay these premiums which would actually reduce the burden on the public health system

dissed doc

creedp wrote: »

I agree with you - there shouldn't be a public subsidy for private services in public hospitals, but I would go one step further and say there shouldn't be a private service in public hospitals full stop. It create perverse incentives for hospitals (to maximise income), for clinicians (to prioritise access to public hospitals in order to maximise income), for insurers (who currently design their policies such that there is no top-up charges if you use a public hospital but there are if you opt for a private hospital) and patient who will will opt for a public hospital to avoid top up charges.

The outcome of the current system is that public patients is public hospital are severely discriminated against in terms of accessing services even if they have a greater clinical need for care.

In relation to €600m subsidy to earn €400m, it looks like the Minister is intending to close that gap on a phased basis but that still means the public patient is disadvantaged in access terms. Furthermore, it is difficult to see how consultants in public hospitals can direct the same level of care towards their public patients as their private ones given the perverse income issue. In other words not only are the public patients disadvantaged in terms of access but also in terms of quality of care. This issue cannot be resolved by narrowing the subsidy. Lastly, the €400m in income only relates to in-patient services and not to outpatient services. Private consultants can refer their fee paying patients to public out-patient clinics for diagnostice, etc at no charge to anyone but the taxpayer. This is another hidden subsidy that is not being addressed. In my view if a private consultant refers patients to public hospital outpatient clinics, it is the consultant that should be charged for the use of public facilities/staff and he can pass this onto his patient.

However, at the end of the day public health services are funded by taxes and all residents should have equal access to quality public health services based on clinical need. If people want to opt for something else then they should pay the risk adjusted premium to receive this care in the private sector. The tax credit on premiums could still remain to encourage better off people to pay these premiums which would actually reduce the burden on the public health system

These private patients have also paid taxes to access the public services like any other.

The public hospitals rely a lot on private insurance to pay the bills. You'd need to suddenly increase taxes a lot to pay for the shortfall - currently paid for by private insurance premiums.

At the moment the "taxpayer" (all of them) doesn't pay nearly enough to support the public hospitals even with the private insurance subsidising them; it's quite amusing to see you suggest the "taxpayer" is subsidising private patients (who pay tax, and also pay insurance to support a public system for those who pay nothing).

GCU Flexible Demeanour

dissed doc wrote: »

The public hospitals rely a lot on private insurance to pay the bills. You'd need to suddenly increase taxes a lot to pay for the shortfall - currently paid for by private insurance premiums.

Not really. As I said only a few posts ago, it costs the State over €600 million in tax reliefs and direct subsidies to get maybe €400 million worth of private income for public hospitals. There's no evidence that private health insurance is relieving the public system of a burden, but there certainly is evidence that private work is adding to the costs of the public system.

dissed doc

GCU Flexible Demeanour wrote: »

Not really. As I said only a few posts ago, it costs the State over €600 million in tax reliefs and direct subsidies to get maybe €400 million worth of private income for public hospitals. There's no evidence that private health insurance is relieving the public system of a burden, but there certainly is evidence that private work is adding to the costs of the public system.

So someone stops the private healthcare and accesses the public system - no change, except now no extra payment to the hosptials. The person still gets/needs the healthcare service, it doesn't disappear, and they have paid for it through taxation.

All that is really the problem, is that other people have an advantage, as opposed to anyone having a disadvantage. If the person skipping the queue went public, it would just add to the already lengthy public queue anyway, and the public queue wouldn't move any faster.

What you really want is for people to keep paying taxes to support publci hospitals, but also when they need healthcare to pay for it privately and in private hospitals. That is essentially the problem: make someone pay for your healthcare , but deny them the right to the same healthcare that is apparently a "right" for everyone.

At the moment, less and less people can afford private insurance, so the public lists grow and grow, as expected. Hospitals have funding shortfalls as the HSE budget is too little to keep them open....

creedp

dissed doc wrote: »

So someone stops the private healthcare and accesses the public system - no change, except now no extra payment to the hosptials. The person still gets/needs the healthcare service, it doesn't disappear, and they have paid for it through taxation.

If there is a coherent public policy approach adopted to remove private healthcare from public hospitals the overall demand for public health services will not increase greatly as the previously private patient will now be treated in same hospital as before but will not now get preferential access based on insurance as all patient will access based on need. Removing private beds from public hospitals would mean all beds available for public patients. As some private people will now transfer to private hospitals then overall demand on public hospitals will not increase. However, individuals will be affected as it is very likely that the previouly private patients will experience a significant increase in overall waiting times while the public patient may well see their waiting times reduce.

As the number of insured persons will reduce the tax relief on premiums and when netted off against private income forgone, the loss to the taxpayer will not be €400m. Also consider that the previously private patients will be a lot better off financially as they won't have to pay on the double to access public hospitals, i.e. no more private premiums!!

All that is really the problem, is that other people have an advantage, as opposed to anyone having a disadvantage. If the person skipping the queue went public, it would just add to the already lengthy public queue anyway, and the public queue wouldn't move any faster

This is not a minor issue - this is the major problem. It seems strange to me that someone thinks that one person having an advantage does not translate to another person having a disadvantage. I presume this is a private patient perspective and not a public patient one. Try tellng a public patient who has to wait for an extended period of time to see a consultant publicly so they can get into hospital to receive necessary care that they are not disadvantaged if another patient can gain much faster access to the same consultant (and therefore a hospital bed and treatment) by paying up €250 fee.

What you really want is for people to keep paying taxes to support publci hospitals, but also when they need healthcare to pay for it privately and in private hospitals. That is essentially the problem: make someone pay for your healthcare , but deny them the right to the same healthcare that is apparently a "right" for everyone.

What I would like is for all patients to have equal access to public hospital services based on need. They have paid for this right through their taxes. No one is being forced to pay for private health insurance and no one is denying them access to private care if they choose to pay for it. The main point again is it OK for two patients of equal clinical need to be treated differently in terms of accessing a consultant and hospital care in a public hospital simply because one of them opts to pay for private health insurance? Preferential access based on ability to pay is not appropriate in a public hospital system.

At the moment, less and less people can afford private insurance, so the public lists grow and grow, as expected. Hospitals have funding shortfalls as the HSE budget is too little to keep them open....

The public lists are not growing because of the number of people leaving private health insurance. Many of the people giving up insurance are young healthy people who do not need to access services at present. In addition, as already said these people are likely to be the ones who had the cheaper policies that required a top up payment to access private hospitals so if they were receiving hospital services as a private patient it was in a public hospital. There are a fixed no of beds and no substanbtial increase in the total number of patients accessing these beds .. so why would waiting lists be increasing?

Also hospitals are currently collecting about €400m a year in private fees which doesn't cover the cost of providing these services plus tax reliefs so there would be a minimal overall impact on the taxpayer. To mitigate further the budgetary impact, the Govt could simply transfer the tax credit savings to the hospitals budgets. Bear in mind that over €2.5bn has been removed from health budgets over the last 3 years with a further €781m being removed this year.

In any case the current Govt are proposing to go down the UHI route and effectively this will remove private patients preferential access to public hospitals as all patient will access on the same basis (call it all on a public basis or all on a private basis whichever way people are idelogically biaised). Obviously people will still be entitled to take our private health insurance and opt for private care in private hospitals but it is doubtful if they will have the protection on community rating for this insurance. Having said that I dont know how UHI will evolve (if at all!)

GCU Flexible Demeanour

dissed doc wrote: »

So someone stops the private healthcare and accesses the public system - no change, except now no extra payment to the hosptials. The person still gets/needs the healthcare service, it doesn't disappear, and they have paid for it through taxation.

Sorry, you're missing the point. The point is the taxpayer would gain from not having to fund tax relief for health insurance and from not having to pay to keep private patients in public beds. The amount gained would be more than the income earned by hospitals.

Farmer Pudsey

The minster is finding that as he adds cost onto Health insurers he is getting more and more public patients. It is reaching tipping point. The age subsidity is noe between 25-30% of private health insurance bill. If it reaches tipping point and people in the 40's and 50's with kids in college have to leave the system or even take there kids off the policy then the cost of health insurance will sky rocket.

It seems that the VHI wanted to impose a 15-20% increase and the minster talked them into a 8% rise. This is not sustainable.

A lot of contribitors fail to appreciate that a large amount of tests, scans and minor procedure for private patients take place in private clinics/hospitals. If people continue to leave health insurers then the cost will become prohibitive to older VHI clients. This might see a situtation where people with insurance let it go and decide to go public or private on a case by case basis and chance paying for it themselves if needed and cliaming the tax back.

Yes there is an issue with consultants however this is a disaster that the HSE and the Dept of Health left come to a head by themselves.

Geuze

How is people leaving health ins now going to work, when compulsory UHI is to be introduced in 2016?

creedp

Geuze wrote: »

How is people leaving health ins now going to work, when compulsory UHI is to be introduced in 2016?

I would have thought the two issue are unrelated. People leaving privateinsurance would be in the same situation as persons who never have private insurance. If (possibly big if) UHI is introduced, then people will have to enter into a new insurance contract with a specified insurer to covering the health services provide under the standard UHI insurance product. It will be up to each individual to either continue with their private insurance policy or cancel this policy. I would imagine in those circumstances the majority will cancel.

Godge

GCU Flexible Demeanour wrote: »

I think there's a few balancing factors that have to be kept in mind. Firstly, the folk dropping cover are not likely to be the ones who claim. They're likely to be the younger folk, who rarely seek treatment. Also, recall that the Comptroller and Auditor General found that half of private patients are seen in public beds - placing a cost of a few hundred million on the public service. Plus, tax relief adds another cost of a few hundred million on the public purse. Between those two things, the taxpayer is shelling out something of the order of €600 million in public subsidy to get that €400 million in private income.

Now, I do take your point that if the private system vanished overnight, we could well have much the same patients turning up to be seen in much the same hospitals by much the same doctors. I'd just feel that the logic of public subsidy for private insurance doesn't stack. I'd basically agree with that, and I wouldn't see a sudden elimination of public subsidy as feasible. However, it would strike me as sensible if the policy was to phase out public subsidies over a few years, with the ultimate destination being the cessation of private work in public hospitals.

You may be undersetimating the tax relief costs.

Coverage was 48% of population 2-3 years ago, assume that has dropped to 45%
Population is 4.58m, 45% is €2m.
Average premium is €1,000 (plans range from €500 to €4,000), giving average tax relief (@ 20%) of €200.
Total cost of tax relief is €400m.

dissed doc

GCU Flexible Demeanour wrote: »

Sorry, you're missing the point. The point is the taxpayer would gain from not having to fund tax relief for health insurance and from not having to pay to keep private patients in public beds. The amount gained would be more than the income earned by hospitals.

No, I get the point and the fault reasoning entirely. The taxpayer includes the private patients. All that happens is they stop paying private insurance, hospitals get less money, but the hospitals have to pay *anyway* as now they are public patients.

The private patient is not some bogeyman - they are paying taxes also, and now simply go onto the public list (with 400,000 others). The don't disappear. UHI will become mandatory because it is impossible to fund the hospitals otherwise. The tax benefit you refer to is a pittance compared to the cost of putting 50% of the country with private insurance onto the public waitlist. How about 800,000 people on the waitlist instead of 400000 at the moment?

GCU Flexible Demeanour

dissed doc wrote: »

No, I get the point and the fault reasoning entirely. The taxpayer includes the private patients. All that happens is they stop paying private insurance, hospitals get less money, but the hospitals have to pay *anyway* as now they are public patients.

Know, you still haven't comprehended the point. The point is that what the public system collects in private income is cancelled by the cost of tax relief. There's no net gain.

dissed doc wrote: »

The tax benefit you refer to is a pittance compared to the cost of putting 50% of the country with private insurance onto the public waitlist. How about 800,000 people on the waitlist instead of 400000 at the moment?

Hyperbole. About half of private work would take place in private hospitals, plus privately insured people spend significantly less time in hospital, on average, than medical card holders.

Farmer Pudsey

GCU Flexible Demeanour wrote: »

Know, you still haven't comprehended the point. The point is that what the public system collects in private income is cancelled by the cost of tax relief. There's no net gain.Hyperbole. About half of private work would take place in private hospitals, plus privately insured people spend significantly less time in hospital, on average, than medical card holders.

At this stage the tax relief on private health insurance all goes to the risk equalisation fund. You seem to think that all private health insurance money should go into the public system . In reality the reason that most people with health insurance patients spend less time in hospitals is the health insurers pay a set fee /procedure to hospitals so it is inthere intrest not to have them bed blocking.

If a hospital gets 5K for a procedure it is in there intrest to discharge the patient as soon as possible also health insurers pay for there clients for 1-2 week in a nursing home again so no bed blocking. A public patient may be unwilling orunable to fund a nursimg home and the HSE budget may have run out also a bed blocker costs less in the system.

If private health insurance gets too expensive for older clients the hospitals will find that they have up to 50% more patients with 4-600 million less to fund the system.

creedp

Farmer Pudsey wrote: »

At this stage the tax relief on private health insurance all goes to the risk equalisation fund. You seem to think that all private health insurance money should go into the public system . In reality the reason that most people with health insurance patients spend less time in hospitals is the health insurers pay a set fee /procedure to hospitals so it is inthere intrest not to have them bed blocking.

Not sure what you are saying here - tax relief is tax revenue/income forgone - the Govt cant use is for anything as its in the pocket of the individual.

If a hospital gets 5K for a procedure it is in there intrest to discharge the patient as soon as possible also health insurers pay for there clients for 1-2 week in a nursing home again so no bed blocking. A public patient may be unwilling orunable to fund a nursimg home and the HSE budget may have run out also a bed blocker costs less in the system

Public hospitals charge private insurers using a daily rate not a cost per procedure. So basically they charge the same rate per day whether you are getting your toe nail removed or a heart transplant. Private consultants get paid by procedure - the hospital never sees this money .. it ends up in the wallet of a doctor who the hospital pays over €200k a year to work for it! It should also be in the interest of public hospitals to discharge public patients quickly however as you say if budget is bust them bed blockers are great as they do not consume expensive acute services. This is why the old approach where hospitals get a block grant in advance thats not related to activity is plain wrong. Hospitals should be paid for work done - which is what money follows the patient is all about. This is how private hospitals work and so are incentivised to increase throughput to increase profit. Of course the insurers dont like this as it increases their costs.

Farmer Pudsey

creedp wrote: »

Not sure what you are saying here - tax relief is tax revenue/income forgone - the Govt cant use is for anything as its in the pocket of the individual.



Public hospitals charge private insurers using a daily rate not a cost per procedure. So basically they charge the same rate per day whether you are getting your toe nail removed or a heart transplant. Private consultants get paid by procedure - the hospital never sees this money .. it ends up in the wallet of a doctor who the hospital pays over €200k a year to work for it! It should also be in the interest of public hospitals to discharge public patients quickly however as you say if budget is bust them bed blockers are great as they do not consume expensive acute services. This is why the old approach where hospitals get a block grant in advance thats not related to activity is plain wrong. Hospitals should be paid for work done - which is what money follows the patient is all about. This is how private hospitals work and so are incentivised to increase throughput to increase profit. Of course the insurers dont like this as it increases their costs.

Creepd DCU had posted that the public hospitals recieve less from the health insurers than there clients get in tax relief. I change the comparison the tax relief on my families health insurance is 25% less than the government levy it is 1045 compared to 767 euro in tax relief. This is the same accross all health insurance policy's the leavy is 285/Adult ( even if a 3rd level student) and 85 for a child . It equates to 34% of my health insurance bill about 6% goes on an insurance leavy and the rest goes to the older patients. Now I am border line in giving up health insurance if the tax relief goes I will either give it up or consider removing the childern from the policy. There will be an exit of young to middle aged families from HI if the tax relief goes and after that the HI companies will have to increase costs by 30-40% ndonly the very wealthy will be able to afford it.

GCU Flexible Demeanour

Farmer Pudsey wrote: »

At this stage the tax relief on private health insurance all goes to the risk equalisation fund.

This is just wrong. The risk equalisation fund is self-financed through the levy placed on policy holders. It is totally separate to the tax relief at source granted in respect of premiums.

Farmer Pudsey wrote: »

You seem to think that all private health insurance money should go into the public system .

I haven't said anything even remotely like that.

Farmer Pudsey wrote: »

There will be an exit of young to middle aged families from HI if the tax relief goes and after that the HI companies will have to increase costs by 30-40% ndonly the very wealthy will be able to afford it.

There certainly is, and will continue, to be an exit of younger subscribers. But you have to avoid the hyperbole. Premiums have increased by something like 80% since 2008. But coverage has only fallen from a bit over 50% to something around 46% of the population. I'd suspect that a phasing out of tax relief (in practical terms, abolition would have to be spead out over a few years) might drive coverage down to 40%, or below. But demand for health insurance is inelastic. People are very slow to cancel.

So, yes, coverage would fall. But a significant portion of the population can be expected to keep cover - and, in particular, the well-off debt-free pensioners that you'd expect to generate the most costs for the public system if they dropped out.

creedp

the size

Farmer Pudsey wrote: »

Creepd DCU had posted that the public hospitals recieve less from the health insurers than there clients get in tax relief. I change the comparison the tax relief on my families health insurance is 25% less than the government levy it is 1045 compared to 767 euro in tax relief. This is the same accross all health insurance policy's the leavy is 285/Adult ( even if a 3rd level student) and 85 for a child . It equates to 34% of my health insurance bill about 6% goes on an insurance leavy and the rest goes to the older patients. Now I am border line in giving up health insurance if the tax relief goes I will either give it up or consider removing the childern from the policy. There will be an exit of young to middle aged families from HI if the tax relief goes and after that the HI companies will have to increase costs by 30-40% ndonly the very wealthy will be able to afford it.

I agree with you over the implications of the levy on younger subscribers to subsidise older subscribers. This is what will eventually make the current Irish private health insurance model unsustainable. Younger people will leave and/or won't take up insurance until later in life. All of this will put even more pressure on the system with the Govt continually increasing the levy to ensure older subscribers aren't hit too hard. This will lead to further defections, etc, etc, Its a vicious circle.

As I said earlier the only way to make community rated health insurance sustainable is if it becomes compulsory for all above a certain age or all earners. You cant have a community rated system that protects older people from higher premiums but allows these people to join later in life and therefore not have contributed their share as young inexpensive subscribers. But like a lot of things in this world some people want their cake and eat it .. however in the real world the cake is soon eaten!