A new government in Ireland might bring health care change

Dr. Muiris Houston

About Dr. Muiris Houston

Medical journalist and health analyst Muiris Houston is a regular health analyst on television and radio. He was medical journalist of the year in Ireland in 2001 and 2002. His major research interests are narrative medicine and patient safety.

Ireland is in the throes of an election campaign, and health care has been a campaign issue, though, nowhere near the top of the list.

If the health manifestos of Fine Gael and Labour, the two political parties most likely to form the next government are serious, then the time has come to adopt a universal health care model here.

The country has put up with a two-tier health system for many years. A major selling point of a new system is the notion that medical care will be prioritised by need rather than by an ability to pay. The manifestos of both parties’ commit to a major expansion of primary care. Labour, a socialist party, would phase in free general practitioner care over four years. The centrist-right Fine Gael party says free family doctor services will be “fully bedded in during the second term of a Fine Gael Government.”

Links across the Atlantic
Muiris Houston writes of a problem in Ireland with insurance companies raising their premiums to levels that hurt many policyholders, especially older ones. That’s similar to what’s happening in the United States where insurers have raised their premiums too. A year ago the 39 percent increase announced by Anthem in California helped push health reform to the finish line when outraged policyholders and public officials flocked to the press to tell their stories.

Rate increases haven’t stopped, but the U.S. media haven’t rushed to write much about them this year, and they should. Victoria Colliver, the health reporter for the San Francisco Chronicle, told me she has been writing about insurance rate hikes for years and has seen increases larger than 39 percent, but they haven’t gotten much attention until it became politically advantageous for people to talk about them.

One place to begin is to look at the press releases from state insurance departments and from state attorneys general. They indicate whether the state took any action to approve or disapprove a rate filing. They are good clues and can spark story ideas and follow-ups. At AHCJ’s annual conference there will be a panel on covering insurance that’s designed to help reporters get traction for stories on insurance rates – and bypassing the political grandstanding of your state’s politicos.

For those tackling the subject, connecting with Houston in Ireland about the fallout resulting from high increases in his country and changes they have brought could add some rich context.

– Trudy Lieberman

Labour says its proposals will cost 490 million euro and will be paid for, in part, by savings in the national drugs budget and by a significant cut in the salaries of hospital consultants. Fine Gael says that money will follow the patient, by which it means hospital productivity will increase by between 5 and 10 percent.

A report from Dublin City University, “Implementing Social Health Insurance in Ireland,” provides an independent analysis of universal health insurance. It endorses the health insurance model. Under that model, care needs to be patient-centered, not determined by the needs of institutions. Access to care must not depend on patients’ resources. The report also says that a system which places a high priority on equity and social solidarity can be built and be delivered within the existing budget. Such a system must have accountability, visibility of outcomes, resources and activity.

The report also points to the need for a much tougher regulatory regime if equity and accountability are to underpin a universal health insurance model. Given recent decisions by two of the three national health insurance companies to effectively drive older people out of the private insurance market, it is clear a workable method of risk equalization must be central to any new plan.

The recent hike in health insurance premiums announced by Ireland’s biggest provider of private health insurance has shocked many policyholders. With some 62 percent of the market, the Voluntary Health Insurance (VHI) has, until now, had unquestioning support from the middle class. However, by targeting its biggest category of policyholders with a selective 45 percent increase for policies renewed this month, the insurer has cast aside the trust of many long-term subscribers.

Since its inception, the clear understanding was that VHI customers who stayed with the health insurer through their lifetime would not face exorbitant premiums as they aged, and their health needs increased. The principle of community rating was seen as a non-negotiable sine qua non of private Irish health care. However, that has been swept aside in what some experts say may be a move by insurers to rid themselves of customers over age 65.

While there are many complexities to the insurer’s decision, they have been of little concern to its customers. Many were having trouble paying rising premiums even before this latest rate increase. Even those who can afford to continue to pay the high premiums may even stop and ask themselves: Is it wise to continue?

Put in the context of the level of acute medical procedures, such as the sudden need for a cardiac bypass operation, costing in the region of 20,000 euro, a decision to continue paying the cost of insurance may seem obvious. However, older people have a greater need for quality, on-going care for chronic illness then they do for “magic bullet” procedures. Historically, private health insurers have haven’t paid very well. A person suffering a stroke and cared for in a private hospital will find that in many cases, the insurer does not cover the cost of speech therapy, occupational therapy, and other essential elements of stroke unit care, that are routinely provided in the public health system.

Fixing our health system will require the full attention of the next government. But if a cost-effective solution ends the long-tolerated inequity in health care, many in Ireland believe it will be worth it.

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