Election op-ed  18/02/2011

While most parties  are offering the Irish population some form of “Universal Health Care” most notably Fine Gael and Labour it is very likely that two terms of office will be required for these objectives to be fully achieved.

The underling expectation of this initiative for current public patients, is, that there access to health care will remain the same as it is currently for privately insured patients with the caveat “when “Universal Health Care” is fully implemented”

In the meantime, recent massive price hikes in private health insurance many multiples of the consumer price index continues to put pressure on the affordability for Private Health Insurance for approx Two million One hundred and thirty seven thousand members (approx 48.8% of the Irish population).

Leakage of members driven by the economic environment over the past three years (Irish Patients’ Associations est. 123,000) has three major effects; firstly, where members  who drop out fall back on an already pressured pubic health care system, secondly this reduces income for a financially challenged public system which needs reform, and reduces income for insurance companies that must be passed on to the remaining members, (IPA’s estimate of this “volume reduction” means some €117 million over past three years passed on to existing members)

Political leadership in government is required urgently for the 2.1 million members of health insurance schemes to maintain stability in the current Irish Health Insurance Market by implementing what is commonly referred to as Risk Equalization or “Risk Smoothing “.  While much ado is being made about “risk smoothing” retrospectively in Ireland, the Dutch are now shifting from risk-smoothing after the fact to implementing it even before the fiscal year begins.

Further efforts to enable greater competition in the current market should be considered such as all of the health insurance companies posting their price increases on the same day and time, competing for a €1billion plus market similar to a public tendering process. It would also remove any perception of price shadowing where one company announces a price increase and takes the flak and others to follow a short time later.

We contacted the Health Insurance Authority (H.I.A) and they said “They couldn’t support this proposal because the Competition Authority may have a view”.

We then contacted the Competition Authority and were surprised that they at the least would not have welcomed the proposal for further consideration. Their concern is of the Insurance Companies that  “If each knows that the other is going to announce prices on a certain day, there will be an incentive for them to talk to each other beforehand”. Yet we understand that the Australian Minister of Health announces all the Health Insurance price movements on April 1st ..

Perhaps the Competition Authority needs a little competition itself ?

In a short time, the IPA spoke to two major players in the marketplace and they would consider such a proposal subject to certain caveats to protect them, such as the Government not adding extra cost on them the day after they announce their price increase.

In the final analysis for the 2.1 million members ( and falling ) of private health insurers  about whose interests on this issue  we have heard little of in this election – the current  market is stressed from membership leakage, it requires a timely and  transparent “risk smoothing” to protect community rating, and innovative ways to stimulate further  transparent competition until a universal system is implemented in full.

What do the various political parties and groupings propose?   

Stephen McMahon



Editors Notes

copy of competition emails on request




Press Release 10/02/2011

“We can reform our Health Service in many different ways” Knock it down Rebuild it! consolidate it! regionalise it! localise it!

We can politise it! de-politise it! consult widely etc, it is an ever ending loop of activity

For the patient on a trolley waiting for a bed, all this activity means little, as it is unproductive and will not deliver “Patient Centered Care”.  Until the fundamental issue is addressed i.e. that the “safety and quality management culture” is practiced by everyone, in all corners of the Health Service, that is the leadership challenge at all  levels, from Government to Public Service and including the front line!