INCREASES IN health insurance premiums, initially by the State’s biggest provider of private health insurance VHI and last week by one of its rivals, Aviva, have been a source of deep shock to many people. With some 62 per cent of the market, the VHI in particular has been been afforded unquestioning middle-class support – until now. But by targeting its biggest category of insurer (those in Plan B) with a selective 45 per cent increase for policies renewed from tomorrow, it 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 needs increased. However, that has been effectively swept aside in what appears to be an attempt to rid itself of customers aged over 65. Equally, Aviva’s 14 per cent price rise seems calculated to close the door on some of them too.
Although the VHI’s decision has complex antecedents, these are of little concern to its customers. Many were experiencing hardship in an attempt to pay rising health insurance costs prior to the latest bombshell; now, even those who can afford to continue to pay inflated premiums must ask: is it wise to continue?
Analysed at the level of acute medical procedures such as the sudden need for a cardiac by-pass operation, costing in the region of €20,000, a decision to continue may seem obvious. However older people have a greater need for quality on-going care of chronic illness than they do for “magic bullet” procedures. Historically private health insurers have performed poorly in this regard. A person suffering a stroke and cared for in a private hospital, will find that in many cases, the VHI 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. Private hospitals do not in general offer diabetes day centres or cardiac rehabilitation, aspects of care that contribute greatly to a person’s quality of life.
According to the Department of Health publication, Health in Ireland: key trends 2010, the four leading causes of death here are heart disease, stroke, cancer and chronic lung disease. Older people considering renewing premiums might do well to ask their existing insurer – or potential alternatives – about the specific benefits they offer for these chronic diseases.
At a broader policy level both the former Minister for Health Mary Harney and the VHI have attempted to muddy the waters by introducing elements of a report prepared by Milliman consultants to the debate. The US firm’s analysis of the health insurer’s cost base has floated the idea of the VHI becoming a US-style healthcare utilisation company. Also known as healthcare managed organisations (HMOs), many have a track record of denying patients medically prescribed treatments. With a modus operandi of prior treatment authorisation and the retrospective review of costs, introducing a managed care model in the Republic can only make an already fraught situation infinitely worse.