Emerging Trends in the Irish Health Insurance Market

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Emerging Trends in the Irish Health Insurance
Market

• Gearoid Gilley
• General Manager-Group Business
• Vhi Healthcare

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Topics

• Our Public Health System
• The Health Insurance Market
• Future Trends

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Part 1Our Public Health System

• Health Service background
• Healthcare Reform 2008
• Patient Eligibility

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Background

• Free Access to Public Care since 2001
• Category eligibility
• Funded through Taxation

Public Healthcare

• Establishment of Health Insurance 1957
• Insuring 15 population initially
• Both Systems complimentary

The Public Private Mix

• Eliminate Hospital waiting lists
• Dedicated bed stock for Public Private patients

• National Treatment Fund
• Co-Location facilities

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Health Service Reforms

• Rationalise agencies
• Health Services Executive (HSE)
• Health Information Quality Authority

Key Elements
Right Care in the right setting

• Needs
• Services
• Funding
• Outputs

Patient
Structures for Delivery
Deliver an improved health system which provides
consistent patient centred care
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Healthcare Agencies

• Dept Of Health and Children
• Policy formulation ensure its implementation
• Health Services Executive
• Responsible for operating Healthcare Personal
  Services
• 100,000 Direct/Indirect Staff
• 15 Billion Budget
• Four Locations nationwide

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Citizen Eligibility

• Category 1 Medical Cards
• All health services including GP services,
  prescription drugs and hospital services free of
  charge.
• Means tested Income Criterion
• 34 of population
• Over 70 Years Medical Cards
• GP Visit Card

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Citizen Eligibility

• Category 2 All of Us
• Free Public Hospitals except
• 65 x 10 Days 650
• Prescription Drugs up to 85 per month
• Dental PRSI
• Check up / Polishing / Contribution to Major
  treatments
• Optical
• Eye Test / Frames of a certain type of frame

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Part 2The Health Insurance Market

• The Health Insurance Consumer
• Market Regulation
• Product development

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Current Insurers
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Consumer Demand

• Access to Private Healthcare
• Indemnity for private treatment costs
• New medical technology Drugs
• Hospital / Accommodation / Doctor choice
• Primary Long-Term Care
• Support services in Sickness and in Health
• Tax Relief at source on Health Insurance premiums

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Vhi Claims Payout

• 1.2 Billion Annually
• 102 Million in Cork
• Claim type example
• Cancer 144 M
• Cardiac 116 M
• Substance Abuse 7.9 M

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Health Insurance Authority

• Regulatory body
• Monitoring Researching
• Risk Equalisation Scheme
• Maintain the Register of Health Insurance
  undertakings
• Safeguard the interests of current and future
  consumers

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Market Rules

• Open Enrolment
• Lifetime cover
• Minimum Benefits
• Community Rating / Risk Equalisation

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Community Rating

• Insurers must charge the same premium
  regardless of age,gender,current or prospective
  health status

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Risk Equalisation

• Transfer of payments from one insurer with
  healthier than average members to those with less
  healthier members.
• Aim is to spread some of the claims costs of
  high risk members amongst all health insurers in
  proportion to their market share

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Health Plans
Benefit Types
Product Solutions

• Hospital Day Care
• Day to Day Bills Outpatient
• Maternity Care
• Lifestyle Benefits
• Dental Care Insurance
• Travel (Holiday Business)
• Patient expenses
• Support (Telephone/Portal)
• Workplace Well-being

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Insurers Adding Value

• On-Line Healthcare
• Straight through Policy Administration
• Employee assistance programmes
• All Insurers active in promoting customer wellness

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• Irelands first urgent care centres

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Future Trends
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The Health Agenda 2008

• Health Services
• Health Reform Programme
• Collaboration with Private sector
• Quality delivery (HIQA)
• Future funding challenge

• Health Insurance Industry
• CertaintyMarket regulation
• Product innovation ..a key driver!
• Its a Growth Industry
• Age of Entry Premiums
• Claims Cost Control / Value for Money
• Making available latest healthcare options
• Consumer focus on well-being

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Your Questions?