Health Insurance

Would I pay the exact same premium as is paid on my behalf now? Perhaps not, I might well shop around for a cheaper one (we're offered a given plan that is procured at a company level to take or leave, vs some other employers who reimburse up to a value for it, so I've never had cause to go looking for the best value), but I would definitely not be without some form of health insurance so long as I could afford it at all, and that would have applied even before the implementation of Lifetime Community Rating. What speaks volumes for me regarding its value is the sheer number of HCWs across a variety of professions and disciplines (I know of dentists, doctors, nurses, OTs among others, all working for the HSE) who would not be without it - when so many working within the health service and system have insufficient faith in said service to leave themselves fully reliant on it and will pay out of pocket for additional cover, that's rather telling IMO.

156 a month is crazy money to have to pay

We have a basic enough family policy and we shop around every year and change plans when we get a better offer. It costs about €3k per year on average for the entire family.

Over the years it has provided for a private room in Holles Street for 2 of our 4 kids and my wife (the two other times we got a room in a different part of the hospital); it has allowed me to get an MRI for a potentially life shortening condition when the public waiting list was months long; and it covers my kids especially to go to the insurers clinic for a rapid examination and x-ray if needed if they have a sporting injury which means they are not clogging up hospital a&e for hours (happens a couple of times per year as they all play rugby or GAA).

But the biggest benefit we got was heart surgery for a condition my son had - he would have been waiting at least 3-4 more years on the public system but once he reached the age to get it done it was done privately. His entry into the hospital system when he had the heart condition was via a&e in Crumlin and all of his early years of assessments and tests were in the public system and the quality of care was second to none (the hours of queuing for every visit was the only issue). Once he was identified as a suitable candidate for the surgery he was transferred into the private system and all subsequent care was done privately.

Over the years I've probably paid €50k for private health cover. I think it was worth it but it's a lot. At this stage as I get older I'd be less inclined to let it go in case I need it at some stage.

You can get pretty good policy for approx €120 a month which will include very good day to day expenses such as a percentage back on GP fees, usually 50/%, consultant fees etc. Example would be Laya's Simple Connect, Simple Connect Plus, Connect Simplicity and Laya Inspire Plus. Im not familiar with the other healthcare companies.

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.

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.

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.

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.