THE ECONOMIC downturn should carry a health warning: the recession can be very bad for your health. Thousands of middle-income earners are leaving private health insurance or downgrading their coverage.
In addition, many of those outside eligibility thresholds for medical or doctor-only cards say they are avoiding visits to the GP, deferring health screenings or even skipping medication.
Your health may well be your wealth. But try telling that to people struggling with even bigger priorities such as coping with large mortgage payments or trying to make ends meet on dramatically reduced incomes. But at what cost?
Doctors are increasingly worried at the longer-term health effects of people saving money by forgoing preventive care or trying to self-medicate health problems.
“We see many people who think they are economising by skipping a visit to the doctor,” says Prof Des O’Neill, a consultant geriatrician based in Tallaght hospital. “But these are often the people who are presenting later on in our accident and emergency units with much more serious conditions.”
There are also troubling questions over what impact the decline in household incomes will have in the longer term on health cover.
Will private health insurance – that staple of middle Ireland – end up being the preserve of the wealthy few? Or will the Government’s ambitious plans for universal health insurance help usher in an era of greater equity and bridge the gap in our two-tier health service?
ROLAND ROGERS, a secondary teacher, and his wife live with their five children on the outskirts of Tralee, Co Kerry.
By his own admission, he’s not a risk-taker. He avails of a salary protection scheme and during the good times put aside spare money into additional pension contributions.
Now, though, he’s thinking of taking a gamble.
He’s weighing up whether he can continue to afford health insurance. The cover for the family has jumped up about €600 over the past year.
They’ve moved to different health insurers on three occasions, shopping around for the best possible deal. Even though they’re on the most basic plan available, he’s thinking of taking his name off it.
“I’ve been paying into it for years, so it’s a difficult choice. And then, what happens if you need it? I’m getting older – I’m 42 – but my income is down at least 14 per cent, and with the extra taxes and charges, it’s hard to find the money to justify it.”
If he does leave, he will be one of 123,000 people who have given up their private health insurance since the end of 2008. There are no figures available for those who have downgraded health policies, but anecdotally those numbers are likely to be greater still.
Some 47 per cent of people in Ireland still have cover, compared to 52 per cent three years ago. But how much further will it fall? With medical insurance running way above inflation, further hikes in premiums are inevitable.
The figures don’t show the age group of those who are giving up insurance. However, a national survey just over a year ago by the Health Insurance Authority found that families and young people were the most likely to give up their cover as a result of premium increases.
Industry observers say this could pose a problem for the health insurance industry. Its business model is based on “intergenerational solidarity”, or younger, healthier customers who claim less, subsidising older people, who claim more. If those younger customers leave, then the cost of health insurance will continue upwards.
Before the economic boom, the proportion of the population with coverage stood at about 33 per cent. Even if it doesn’t fall that low, at the very minimum it will leave half a million people who are either without health cover or the safety net of a doctor-only or medical card.
Prof Ray Kinsella of UCD has warned that some of these people are in danger of slipping into a “healthcare/poverty trap”.
In a recent research for the Irish Patients' Association, A Review of the General Medical Scheme – Increased Work Load and Future,he said access to care is increasingly difficult because of pressures on household budgets.
He also warned that rising unemployment and falls in disposable income were leading to more people relying on an already overstretched and underfunded public health system.
Doctors also warn that some financially squeezed patients are skipping expensive medication for chronic conditions or simply don’t turn up for regular check-ups.
“I know it’s wrong, but I feel I don’t have much choice,” says a middle-aged woman, who has stopped taking her asthma medication.
“The ceiling for the drugs payment scheme keeps rising, so there are lots of months where I can’t afford it.”
While the downturn has led to costs reducing across many parts of the economy, the same can’t be said of the health services. There is little or no evidence of any change in GP fees, which typically range between €35 and €70.
The Government says it is responding to many of these issues through its plans for free access to GP care and universal health insurance.
The first phase of free GP care is due to be rolled out shortly, it says, while a White Paper – or discussion document – on its plans for universal health cover is due by the end of this year. This will give the first detailed proposals of how such cover might work.
JOHN MONAHAN (69), from Dundalk, Co Louth, feels angry. He says he was forced to give up his health insurance after a series of premium hikes, despite making contributions for most of his adult life.
“I feel like they’ve been targeting us,” he says. “They don’t want us, we’re too old. We break down too often. And this is the thanks we get after paying into these schemes.” It’s the last thing people need, he says. He feels many in the community are under severe stress due to the economic uncertainty combined with worries over whether they can cope if they experience ill-health.
Dr Terry Lynch, a Limerick-based GP and mental health campaigner, sees this kind of pressure first-hand.
“There is a surge in the levels of distress out there,” he says. “There is anxiety, depression, fear. You see it affecting people’s relationships and impacting on their emotional wellbeing.” A major obstacle is that counselling and psychotherapy services tend to be outside the public health system. While many professionals are cutting their fees, sessions can still range from anything between €35 and €100 an hour.
Dr Lynch says we urgently need to change our system to ensure it responds to underlying causes of people’s distress – rather than the labels of mental illness.
“There is much that people can do themselves, even if they are troubled by financial problems or worried about uncertainty for the future.
“It’s important to focus on the present and what is directly in front of you. You should address problems one by one, taking small steps at a time.
“When we deal with these issues individually, they don’t seem quite as big. And we also get a sense of empowerment.” His most important message, though, is for anyone in distress to seek help.
“Keep searching until you find what works for you. There is a real understanding and empathy out there. It is so important to reach out and ask for help and support.”
'I suppose we thought we were over the hump'
CASE STUDY B:FOR 35 years, private health insurance has been something Edel Moran paid for without a second thought. Until this year. She estimates her premium payments with the VHI leapt by 46 per cent last year, and 28 per cent the year before. On top of that, another 9 per cent hike is on the cards later this month. "In this house, health insurance has always been important," says Moran, in her 50s, a clerical officer from Sligo. "We've paid into it all our adult lives. But our income is down one-third, and our expenditure is up. With premium hikes like that, it's made it very difficult. "We were on the verge of cancelling it this year, but we've downgraded to a cheaper plan for the time being. For how long, I don't know." Moran, whose husband works in IT, is on medication for her asthma which can cost about €140. The increase in the ceiling for the drugs payment scheme to €132 a month - up from €100 a month two years ago - makes this more expensive. In addition, the reduction in tax relief for medical expenditure to the lower rate is taking its toll. She never thought things might get more difficult to afford the older she got. "I suppose I thought we were over the hump," she says. "Myself and my husband were beginning to be able to afford the kind of things we couldn't afford when our kids were growing up. "We'd do last-minute holidays, maybe two or three times a year - last-minute deals. You felt you could loosen the purse strings that little bit. Then, the rug was pulled out from under us." She concedes that she and her husband are fortunate. They both have their jobs. Their children are grown up and are either in work or in the education system. And because they never had much in the way of shares or property, they didn't suffer any catastrophic losses. She worries about the long-term impact of health cuts and whether we as a society are doing enough to protect the vulnerable from the harshest effects of the downturn. "Those kinds of cuts make it very difficult for older people who have paid their taxes and their dues. We're not treating older people with the kind of respect they deserve. They made our society and now it sometimes feels like we're pulling the plug on them."
