Joint Committee on Health & Children

Transcription

1 Joint Committee on Health & Children Mr Dónal Clancy Managing Director Laya Healthcare Dr David Muiry Managing Director, Life & Health Swiss Re November 28 th 2013

2 Laya Healthcare Who We Are? Laya Healthcare established in 1996 by BUPA; Business underwritten by Elips Insurance AG (a wholly owned subsidiary of Swiss Re); 470,000 members; 440 Team members ; Second largest provider c.23% of market; Laya healthcare fully supports community rating & intergenerational solidarity; Four core values: Fair, Grounded, Caring & Innovative.

3 Vulnerable Impacted in Premium Spiral as Market Shrinks The Irish Private Health Insurance (PHI) market is in an upwards premium rate spiral which, if not reversed, will result in the market shrinking to a fraction of its current size in 2014 c. 400m more forced on consumers including Tax Relief at Source (TRS), Public Hospital Bed Charges & Levy; Increase in public hospital charges contributed substantially to cost increases in the market 137% increase since 2006; Levy currently rewards inefficiency and impacts most on those who can afford it least - market rates set are not efficient, Levy compensates VHI, Levy effectiveness should be set at 70% until market becomes more efficient; Market sustainability concern as healthy customers leave the market; Tax Relief at Source cap means consumer pays 170m more across market; Exchequer burden of public health system grows and transition to Universal Health Insurance (UHI) more difficult as a result.

4 Implications for the Market in 2014 Minister intended New Charges to raise 30m in public hospital revenue from PHI customers in 2014 through the public hospital bed changes; Health (Amendment) Act 2013: New Charges cost 130 million (HIA); The Minister categorically said he would amend the rates via the Health Insurance (Amendment) Bill 2013 to raise only the 30m; Budget 2014 capped Tax Relief at Source at 1000 with immediate effect fragile consumer confidence rocked overnight; Complete failure to consult with industry led to a mistaken policy change; 90% of products on the market affected more than gold plated policies; The unfair adult Risk Equalisation Levy has increased by 149% from 160 to 399 since introduction in 2009.

5 Market Implications (cont.) Government policy is not working; Younger and healthier members leaving market in increasing numbers; Significant additional premium increases and market shrinkage projected as a result Public Hospital Bed, TRS and Levy cost increases. Higher Cost/Levy Higher Prices Healthy People Leave Market

6 Stabilise the Market - Real sustainable reform Laya healthcare fully supports community rating and intergenerational solidarity; Risk Equalisation is necessary to support community rating, but imposes a significant and growing burden on younger people and families, so other reforms are needed to ensure market remains sustainable; A system based on DRGs (Diagnosis-Related Groups) should be developed; Aim to have shadow system in place for 2015 and implementation in 2016; Pre-requisite for Universal Health Insurance; Keep young and healthy in the market - Implement some version of Lifetime Community Rating or similar Adjustment Community Rating now - various proposals already put to Department of Health.

7 Risk Equalisation Required Reform Current minimum benefits regime is out-moded and flawed; Community rating should be based on a Standard Product; Customers should be able to buy additional benefits for an additional insurance premium without additional regulation; Will address concerns about the number of products in the market without curtailing consumer choice; Standard Product should facilitate access to both private and public hospitals and cover a defined basket of services; In order to contain costs, an optional excess should be allowed; Above the excess, full costs would be reimbursed for all medically necessary treatment delivered in the defined settings across the network of providers covered by the relevant insurer; Regulatory oversight to ensure that the network providers reasonable access Building block for Universal Health Insurance.

8 Conclusion Government policy must stop forcing people out of the market (Reducing Tax Relief, Increasing Levy, Increasing Public hospital charges); Market Stability is a primary concern, the young and healthy need to be incentivised to stay in the market Implement some version of Lifetime Community Rating or similar Adjustment Community Rating now; Genuine consultation with insurers has worked effectively in the past and is the best way to ensure that policy changes achieve their desired effects; Minister must amend the Public Hospital Rates before 1st Jan 2014 to raise only 30 million from this new charge; The burden of supporting community rating falling on younger people and families is significant and growing Risk Equalisation reform required now; Our position has not changed - Introduce a standard product.

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