It may prove serendipitous that the Voluntary Health Insurance Board has included an additional benefit of £15 for eyetesting biannually in one of the voluntary options it announced yesterday. Reading the small print of competing health insurance proposals from the VHI and its competitor, BUPA Ireland, is likely to increase the feeling among consumers that more eye-testing is required. And even when the competing brochures are well designed and clearly laid out, the need to refer complex calculations of premium payments and relative health-care benefits to pocket calculators is likely to induce a feeling of eye strain, not to mention brain strain.
As the costs of health care continue to rise, and as competition between the two insurers becomes keener, changes in both premiums and benefits are likely to come more rapidly and with more complexity. Claim and counter-claim about who offers the best value for the least payment will become more difficult for consumers to assess as they try to determine how their probable health-care needs can best be covered. Comparisons will become more difficult to make when trying to choose between two options that may well not be directly comparable.
Many governments have discovered how difficult it is to determine and control the cost of providing health care. Some of the developed countries which spend most on health care have the least satisfactory services in terms of meeting health needs. Some that have spent less per capita have provided the best and most comprehensive health-care schemes. Whether in governmental or private insurance schemes, it seems clear from the social, economic and health data available in this century that community rating is critically important if most people are to benefit best from whatever resources are provided. The fact remains always that those groups in society most in need of health care are those least able to pay for it at the time it is delivered. Costs must be spread if their needs are to be met and the overall quality of care is to be maintained.
The VHI Board has increased its charges recently. It is highly likely that BUPA Ireland will have to increase its charges next year if it is to continue to cover its subscribers' needs and to maintain the quality of the services it provides. Neither organisation can ultimately cap the costs of medical and hospital care any more than governments have succeeded in doing. Ultimately, the only way to contain costs is to exercise very sophisticated methods of rationing the provision of health care. This is as true of the private sector as of the public sector.
What the subscribers to both VHI and BUPA have to grapple with as they try to choose between the two insurers is the fact that what is really determining their choice of scheme is the relative efficiency and the actuarial skills of the competing organisations. It has relatively little to do with the quality or comprehensiveness of the health care actually provided. Just as the State can provide what the tax-payers are prepared to pay for in terms of the public health-care services, so insurers can provide the cover that their subscribers are prepared to buy. There is reason to be grateful that the community rating requirements which are at the heart of both public and private provision are built by law into the health insurance schemes here. Extra options are peripheral as well as optional. Subscribers can choose to ride on either the swings or the roundabouts and get, more or less, what they pay for.