Medical cardholders in poorest households spend 10% of income on private health insurance

Medical cardholders in poorest households spend 10% of income on private health insurance

Some of the country’s poorest households are spending nearly a tenth of their disposable income on private health care, despite having medical cards.

A new study has found the number of Irish households going through financial hardship to pay for private medical bills, such as private health insurance along with out-of-pocket expenses like GP and outpatient fees, is on the rise.

The Trinity College research found private health insurance made up nearly 10% of all spending in the nation's poorest households - while it was just over 3% of all spending for the highest earning households.

It found one in five medical cardholders are doubling up by paying for private health insurance.

Health economist, Dr Bridget Johnston, who is one of the authors of the paper, said there appears to be a perception among some poorer households that they need private health insurance to get access to care.

“What we’re finding is households who are basically poor, who are living below the subsistence line and have a medical card are still continuing to buy private health insurance,” said the researcher at the Centre for Health Policy & Management Trinity College Dublin

“It’s probably not surprising given how much coverage there is about waiting lists in the public system.

“There is also the perception that private healthcare is of better quality than public healthcare which there is no evidence at all to support in Ireland.”

She said the study found poorer people are spending a lot more on private health insurance relative to their ability to pay than wealthier households.

Despite the economic recovery, the Trinity College research found the incidence of unaffordable private health spending on out-of-pocket fees and private insurance rose from 15% in 2009-0 to 18.8% in 2015-16.

The research used data from the Central Statistics Office’s Irish Household Budget Survey - which gives a picture of how Irish households spend money week-to-week - from February 2009 to 2010 at the height of the recession and from February 2015 to 2016.

In the study, which has just been published in Health Policy, households were classified as having unaffordable health expenditure if they were poor and reported any spending on private healthcare.

They also fell into the bracket if they were pushed below the poverty line by health spending or if their spending on health was higher than 40% of their disposable income,

Along with private health insurance, the paper identified out-of-pocket expenses such as GP fees, home help, nursing home, dental, outpatient fees, over-the-counter drugs and prescribed drugs as contributing towards financial hardship.

The study found that 16% of spending among medical cardholders classed as having unaffordable expenditure on private health bills went towards GP, inpatient and outpatient care.

The authors said: “There are high levels of spending among households with medical cards for services which should be free of charge in the General Medical Scheme or public system.

“While the reasons for spending cannot be determined through this analysis, it is possible people were seeking services such as outpatient consultations as private patients because of long wait times in the public system.”

Since 2014, there was a charge of €2.50 per prescription item for medical cardholders with a monthly cap of €25.

The researchers found that poorer households, most with medical cards, were disproportionately affected by cost-sharing policies introduced during the economic downturn.

The study concluded that possible policy measures to address financial hardship include broadening the basket of care provided and removing fees.

They added another measure would be to reduce long waits for public hospital treatment so people are not forced to pay out-of-pocket for some private tests and outpatient appointments and are less likely to feel dependent upon private health insurance and private care.

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