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It is becoming increasingly obvious in the inevitable unfolding crisis and clearly unsustainable situation in what we liberally, generously and erroneously call the ‘private health insurance’ and ‘private healthcare’ markets, that these were, and are, unhealthy and distorted markets.
Acknowledging the vital and valuable contribution these entities continue to make in buttressing the provision of healthcare in Ireland, it is worth noting:
1: The generous tax subvention on premiums over the years masked the true cost of the insurance.
2: The unsustainable increases in premiums over the past few years are due, we are told, as a result of the Department of Health exacting the true or approximate cost of the use of public facilities. This begs the question, why was this cost not manifest and exacted over the years?
3: The VHI, still the dominant party in private health insurance, apparently has not maintained adequate capital reserves for many years, perhaps it does not need to because it can always call on the lender of last resort — the public/taxpayer. (In this regard, why was there such outrage when it was revealed that Quinn Insurance did not have the same statutory reserves?)
4: The irregular, arbitrary, and profligate approach to cost and accounting.
There is nothing wrong with such providential behaviour as private health insurance, private healthcare, private pension provision, or private education, etc, but when such endeavours are overly fostered, favoured, facilitated and enabled by, and unduly enmeshed in, public policy, it is not conducive to culturing healthy markets.
No doubt this is a very complex problem that has arisen from well intentioned and ad hoc government policy, but clearly this chimera — the nexus of public and private healthcare, is long overdue a realignment and redirection.
We should give our full backing to the Government in their determination to introduce mandatory universal health insurance, whereby a proportionate amount is contributed by all eligible adults. Dare we imagine and develop an Irish National Health Service, or else follow the Dutch model of private insurance and private/autonomous hospitals and healthcare facilities, overseen by a regulator, the critical aspect of such a model would be rigorous monitoring of costs and accounting, and of course, the “money follows the patient.”
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