Sir, – Minister for Health Leo Varadkar has decided to implement some of the findings of the recent McLoughlin report on reducing costs in health insurance ("Varadkar seeks price freeze deal with health insurers", Front Page, September 8th).
In a report that deserved wider attention, Pat McLoughlin concluded that private patients are poorly served by our current insurance model of care, with its lack of an integrated and comprehensive approach in both primary and secondary care.
The insurance industry says it has to raise its premiums to keep up with changes in medical practice. It seems wedded to this reactive approach even as it loses members.
The introduction of competition has meant our insurers are more concerned with vying with each other for a declining market than they are with becoming players in the healthcare system.
Instead of developing healthcare incentives that can leverage change in our health system, they market complex plans that confuse subscribers. I heard one company recently proclaim that they now had 100 plans available for “customers to choose from”.
All over the developed world everyone agrees that secondary care is too expensive, often inappropriate and cannot be delivered effectively without a vibrant primary care sector. The management of patients with common chronic illnesses such as diabetes, hypertension and obstructive airways disease are good examples of illnesses that needs more and considerably less expensive GP input.
All the international evidence points to general practice as the single biggest moderator of costs in healthcare. Countries with well-functioning general practice spend less of their gross national product on health than those, like ours, with less well-resourced general practice.
If our health insurers want to become involved in delivering appropriate and affordable care to a growing number of patients, this will involve structuring a payments system that rewards integrated and comprehensive medicine.
This cannot be done in an insurance culture that has little or no expertise in general practice. The answers to these questions matter because our health insurers are letting the modern world of healthcare development pass them by. Government needs to facilitate the industry to become players in healthcare with modernised legislation, giving them a place in policy development in return for a commitment to best international practice.
We now know the Minister has read the McLoughlin report and our health insurers would be wise to read it again and act on it in order to serve patients better. – Yours, etc,
TOM O’DOWD, MD
Professor of General
Practice,
School of Medicine,
Trinity College Dublin,
Dublin 2.