Joint Committee on Health & Children

Transcription

1 Joint Committee on Health & Children Presentation on Universal Health Insurance 1

2 Universal Health Insurance - Proposal A Single-Tier Health Service supported by Universal Health Insurance - Social solidarity through equal access to care for all regardless of wealth or health Key Objectives: - Delivering high quality healthcare services - Most efficient delivery of healthcare Delivered through: - Every Citizen insured for a Standard package of care - Universal Primary Care with free access at point of use to GP services - Competing health insurers - Competing health providers 2

3 Universal Health Insurance - Proposal A Single-Tier Health Service supported by Universal Health Insurance Potential Key Measures of Success: - Equal access to care for all - More efficient delivery of healthcare - Financially sustainable healthcare system - Better healthcare outcomes especially for the sickest and most vulnerable 3

4 How Universal Health Insurance could operate Key Regulations: - Mandatory system of insurance - Standard health package defined by Government - No distinction between public and private patients - Insurers free to contract with all providers (public and private) - Freedom of choice of insurer - Money Follows the Patient payment system with all providers - System funded by Government & Customers - Government funding through central taxation & subsidising those that cannot afford - Customer funding through community rated premiums - Some services will continue to be centrally funded e.g. social care - Community rating for standard package - Free market for extras outside standard package - Effective Risk Equalisation scheme 4

5 How Universal Health Insurance could operate 3.2 Flow of money 2011 Government Government contribution Income-related premium Risk Equalisation Fund Funds allocated Per Customer Customer Insurance premiums Health insurers Health Providers Payment for services 5

6 Delivering Competition among Insurers & Providers Make sure financial incentives are aligned to policy goals For Insurers Effective Risk Equalisation critical: - Insurers incentivised to manage costs not select healthier customers - Energy focused on managing healthcare delivery - Innovation in services happens for all patients (including the old and sick) - Will drive administration costs lower Solution required to regulatory capital required (may exceed 1bn requirement) For Providers: - Allow insurers to contract freely (mandating cover will undermine efficiencies) - Inefficient providers cannot be propped up 6

7 Critical Enablers Information and Technology Systems - To record and manage healthcare spend more effectively - MFTP systems in public hospitals - will require over 3m claims process p.a. National Clinical Programmes implemented across full healthcare system Structural Reform and Governance of public hospitals Effective Risk Equalisation scheme implemented Authorisation of Vhi Healthcare 7

8 Critical Enablers Vhi Healthcare critical component: - Pays almost 80% of the costs in private health insurance market 57% market share - process almost 1m Money Follows The Patient (MFTP) claims p.a. - Has infrastructure to implement - Has 50+ years experience managing healthcare reimbursement systems - Have international experience and expertise - Already heavily invested in managing people s healthcare - 30,000 screening completed - HomeCare serviced saved 12,000 hospital bed nights in

9 Learn from International Experience Financial Incentives of Insurers must be Aligned with Policy Goals - Do not incentivise profit making just by cherry picking younger healthier lives - Strong effective Risk Equalisation ensure focus is on cost management, efficiency and good healthcare outcomes Financial Incentives of Providers must be Aligned with Policy Goals - MFTP systems need budget capping mechanisms to manage cost - Develop rewards based on outcomes as opposed to activity Inefficient Insurers and Providers should not be Propped Up Implementation of UHI takes time - Considering implementing UHI in phases 9

10 Summary Vhi Healthcare is committed to supporting the Government on the implementation of UHI across the market Need to ensure all the critical enablers are in place to set up for success Learn from international experience the Netherlands to avoid the pitfalls and to deliver a more robust system for Ireland Set out a realistic timeframe for delivery a phased approach to ensure that any issues that arise can be addressed and risks are mitigated 10