Letter to the Editor of the Irish Times
Helen Hegarty, President MDCA, wrote a letter to the Editor of the Irish Times which was published in their newspaper. She was commenting on the recent price hike from Vhi. As follows is a full transcript of her letter:
Sir, – As president of the Medical and Dental Consultants Association, I would like to comment on the article, “Health insurer VHI announces fresh price hike averaging 3%,” (January 28th).
While most citizens support the notion of a universal healthcare system, it is a fact that as demand far exceeds supply in this jurisdiction, the private healthcare industry is a vital part of the system with 2.5 million or 47 per cent of the population maintaining health insurance.
The rising cost of health insurance premiums (increasing twice annually in March and October) is a matter that must concern the Department of Health, the Health Insurance Authority, Insurance Ireland and other stakeholders.
Each half-year health insurers cite “medical inflation, claims costs and increased demand for healthcare”. They also state that affordability must remain a priority. There are a number of factors that could be looked at if we want to address the cost of health insurance claims.
In the first instance, the Department of Health and the Department of Justice must work with the consultant representative bodies on the rising cost of medical indemnity insurance. The cost of medical indemnity insurance is seriously threatening the viability of private practice.
Secondly, the remit of the statutory regulator, the Health Insurance Authority, must be updated to give the authority greater powers over the health insurance industry.
The authority must have a medical advisory board to assist them in making sense of the claims data emanating from the insurers and specifically both the Health Insurance Act and the Minimum Benefits Regulations, which are significantly out of date and require updating.
This body of legislation governs the risk equalisation scheme, the scheme that supports the insurer with the oldest membership within the community rated model that operates in Ireland.
Thirdly, the Department of Health, the Health Insurance Authority and Insurance Ireland must come together with the consultant representative organisations to create, as they did in the UK, a body to establish a universal schedule of benefits for the entire health insurance industry.
In this way there would be a common understanding of the procedure codes, the procedure or medical service descriptions, the clinical indications, payment conditions and, specifically, the coding.
Currently each insurer has its own coding system, own descriptions, etc, leading to a multiplicity of codes and descriptions which in turn creates confusion, inconsistencies, and leaves the system open to abuse and miscoding.
In the UK there is only one schedule of benefits serving the entire private health insurance market and this provides a more open, transparent, accessible and understandable system for both stakeholders and consumers.
The Health Insurance Authority should be given responsibility for centralising the private healthcare sector where policies should be greatly reduced to about 30-50. This would simplify matters for navigating healthcare policies and medical care.
The authority should be explaining to the public why there are currently 300-plus healthcare plans in the market and why health insurance is so confusing to the ordinary person.
Beyond any doubt, the proliferation of healthcare plans is nothing more than a sick segmentation of the market and gives insurers a way to circumvent the community rating system that has been a cornerstone of health insurance in Ireland since 1957.
If the Department of Health, the insurers, Insurance Ireland and other stakeholders do not come together to address these issues, not only will health insurance become unaffordable, but the number of independent consultants working in full-time private practice will diminish.
This is because the cost of medical indemnity and the costs of running an independent practice will escalate to such an extent that private practice in this jurisdiction will be unsustainable.
We then may end up with a private healthcare industry run owned by external venture capitalists who will erode the breadth and quality of medical treatment of private patients.
Yours, etc,
Helen Hegarty
President MDCA