The Increasing Privatisation of the Healthcare system in Ireland

It’s surprising that NGOs representing older people haven’t been more vocal about recent legislation the South of Ireland which effectively will allow discrimination against older people into the future.

Up until now private healthcare insurance companies in the 26 Counties have had to abide by a policy called ‘Community rating’ when it came to private health insurance costs. This meant that regardless of age or disability, private healthcare insurance companies had to charge people the same rate for the same private health care package.

New legislation from the Irish Coalition Government however, means that from 1 May 2015, people who are 35 years of age or older when they first take out private health insurance will have to pay an extra 2% for each year they are over 34 years of age. Thus a 44 year old will pay 20% higher than a 34 year old, and a 54 year old will pay 40% more, a 64 year old will have to pay 60% more, and so on.

The aim of the legislation is to frighten younger people into buying private insurance now and to promote an increasing privatisation of the healthcare service. No doubt it will do this. However, it also introduces a further element of inequality into the healthcare system – discrimination against older people in future years, if they do not take up private healthcare insurance now.

In 2015, about 45% of people in the Irish state have private healthcare insurance. (Another 41% get free (ish) treatment by a GP and public hospitals because they have a ‘medical card’ due to low income). Thus only about 14% of the population, mainly younger adults, are not covered by either. The aim is to get more people to depend on private insurance for healthcare (Adelaide Society, 2015).

The main benefits of private healthcare insurance to date have related to being able to avoid waiting lists and use private healthcare facilities. However, because many people have been unable to pay private healthcare insurance during the current economic crisis, insurance companies have been losing clients. This latest legislation is aimed at stopping this trend. Insurance companies have also been introducing new ‘cheap’ policies for younger adults – policies which appear to provide little in terms of insurance cover but are attractive because they are more affordable (500 Euros a year instead of 1000 Euros) and at least allow younger adults to become ‘insured’ now, so they will not have to pay the extra charges when they get older and are more in need of private healthcare insurance.

Ultimately, the current Irish Government’s policy is to introduce compulsory private healthcare insurance for all (like Obamacare in the USA) with public subsidies to private insurance companies for those who are poor (http://health.gov.ie/wp-content/uploads/2014/04/UHI-Explained-.pdf ).

Private healthcare is of course already heavily subsidised by public taxation.

Taxation contributes about 75% of total health expenditure in the Irish state (OECD, 2011; Adelaide Society, 2015).
Out of Pocket payments contribute about 15% of total health expenditure. (These include the 60 Euros charges for each visit to the GP, the 75 Euros charge for each day spent in a hospital for tests or treatment, the 100 Euros charge for visiting the Accident and Emergency ward in a hospital, the charges for calling an ambulance, and of course the cost of medicines (which aren’t subsidised), etc.

Only about 10% of total healthcare expenditure actually comes from Private Health Insurance. Yet being able to pay for private healthcare insurance can have a major influence on access to adequate healthcare in the Irish state,

Tax relief is available for those paying private insurance and for ‘out of pocket’ medical expenses. However the biggest subsidies are in the fact that medical schools, nursing schools, hospitals and indeed most healthcare services are heavily subsidised by taxation.

Thus in the Irish state unequal access to healthcare is heavily subsidised by public taxation.

There is of course no rational reason why we should promote privatisation of the healthcare service.

Private healthcare ensures the continuation of a two, three, four, multi-tier system of healthcare where the more you pay the more you are likely to get from the healthcare system.

It promotes inequality of access to healthcare because access is based on the type of private healthcare policy you are able to afford.
In Ireland the new legislation already means that premiums will in the future be based on age and this will promote further inequalities in access.

Increasingly Ireland is also likely to move towards the system in other countries where insurance premiums and what they cover will be dependent on, prior conditions, disability, etc.

Increased privatisation of healthcare also leads to increasing costs of healthcare, as has been shown in the case of the USA and the Netherlands. The costs of healthcare are driven up due to the fact that (a) profits are being made on the back of people’s suffering and (b) there are increased administration costs due to more and more private insurance companies trying to make a fast buck out of people’s illnesses.

The best healthcare systems are those whose provision is based solely on need –not ability to pay; those free at the point of care and paid for out of general taxation.

Despite all its faults (which are mainly due to persistent underfunding) the British NHS is still one of the better healthcare systems in the world. It is also one of the cheapest to fund – about 8-9% of GDP compared to 17% for the USA system, 12% for the Netherlands and between 10-11% of GDP for most of the other richer states in the world.

It stands to reason that if the profit motive is removed from healthcare, costs will be reduced. It also stands to reason that people should be treated equally based on their health/ill health rather than on ability to pay.

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About Féilim Ó hAdhmaill

Dr. Féilim Ó hAdhmaill is a Lecturer in Social Policy in the School of Applied Social Studies, University College Cork, Ireland. His subject areas are Comparative Social Policy; Conflict Transformation and Peace Building; Community Development and he is Programme Director for the Masters in Voluntary and Community Sector Management. University profile http://research.ucc.ie/profiles/A012/fohadhmaill For information on the Masters in Voluntary and Community Sector Management http://www.ucc.ie/en/cke75/ He has a long background working in community and voluntary sector and as a political activist in the North of Ireland. He is a former republican prisoner who spent seven and a half years in prison. He was released from jail in August 2000 under the Good Friday Agreement. He has lectured in social policy at Queens University Belfast and Ulster University and have been a lecturer in University College Cork since 2006.
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