4 August 1999 Edition
Healthcare market promotes inequality
VHI premiums rise by 9%
BY ROBBIE MacGABHANN
How are you feeling today? A little unwell maybe? Good, because a whole host of companies and organisations are waiting to profit from your illness. This is thanks to the dictats of the EU and the free market ideology that permeates the economies of Europe. Your sickness means you have entered the healthcare market.
This market, like many others, is riddled with exploitation and double standards, with the Dublin government actively promoting inequality.
So, say you do feel unwell. Most people wait a few days and then make the trip to the family doctor. Some people have medical cards and this service is free. At worst, such a visit will cost you £20 plus.
If you need to visit a hospital, the fun really begins. You can enter the hospital system as a public patient. The problem here is the waiting. There are two forms of queues. The first is the queue for an appointment with a consultant. People waiting for such an appointment are not counted in the official statistics.
If you do get an appointment with a consultant, it does not guarantee that you actually receive treatment. Over 34,000 people were waiting for hospital treatment at the beginning of 1999. This was despite a five-year-long hospital Waiting List Initiative (WLI).
The levels of waiting lists for coronary bypass surgery and hip replacements are among the longest in Europe. Data from the European Renal Association shows that Irish patients are far less likely to receive kidney dialysis than citizens of most other developed states. The 26 Counties has the lowest number of specialists than any other developed state.
The most maddening aspect of the waiting list crisis is the fact that successive Dublin governments have actually implemented policies that have increased hospital waiting lists.
In the 1980s, over 2,000 beds were taken out of the hospital system by government cutbacks. They have never been replaced. At the same time, the Dublin government subsidised over 2,000 private beds in public hospitals. Up until the start of 1999, the government paid 50% of the costs and the hospitals keep the income they make from these beds.
Now successive health ministers have been encouraging hospitals to set aside more public beds for private patients so they can increase fee incomes.
Bypass waiting lists
If you do not want to join a waiting list, you might follow the example of over 1.5 million people in the 26 Counties. They have taken a second option to bypass the worst of the waiting lists. They pay annual premiums to the VHI or the British company BUPA. VHI has 1.46 million subscribers. BUPA has over 100,000.
The most popular VHI plan, Option B, will cost over £340 a year per person when this year's 9% increase is included on bills. The most popular BUPA plan, Essential Plus, costs 22% less. This is partly due to the fact that BUPA's subscribers' age profile is considerably younger than the VHI's.
Costs at the VHI have increased by over 70% in the 1990s, outpacing inflation considerably. The main reason for these increasing costs is that new medicines, mostly expensive, and new medical treatments are being continually developed. Added to this is the fact that VHI subscribers are ageing and more claims are being made on the insurance company's funds.
The VHI was set up as a semi-state company to provide cover for people not included in state health insurance schemes. Now it has grown into an insurance company that subsidises the underfunded hospital sector. People who can afford it buy VHI cover to avoid waiting lists. The more people in the VHI, the more the state can underfund the health service and promote steps that undermine the public service in favour of the private.
Those who pay VHI premiums every year do it to avoid the high costs of hospital bills if they or their families ever get sick. Every year, the costs of these premiums are increasing. The consumers in the health insurance market are being charged for products they have not yet and maybe never will actually consume.
The health market that has emerged in the 26 Counties is a two-tier one, with those who have low incomes getting the worst service. Then there are there VHI/BUPA subscribers and those who pay privately without insurance cover. The more money you are prepared to pay, the better the service you will get.
The VHI has 95% of the health insurance market. This market share must be privatised and made more competitive as a result of a 1994 EU directive. The Dublin government is currently considering finding a strategic partner for the VHI following in the footsteps of Telecom and Aer Lingus.
All during 1999, we have been promised new legislation on privatising the health insurance market, yet with the government now effectively on holidays, the legislation has still not appeared.
Last week, Brian Cowen decided not to exercise his veto on the new round of VHI premium increases. Earlier this year, he was found to have hoarded £32.5 million in unspent funds while waiting lists were increasing and four of Tallaght Hospital's 12 operating theatres were closed because of lack of funds.
It seems that Brian Cowen and his department are more intent on book-keeping and dithering than providing a proper health service.
Will a market for health services mean an end to waiting lists, to queuing in hospitals, to waiting for an actual appointment? It might for those who can pay the highest prices.
For the vast majority, it will mean more expensive insurance, more waiting and a reduction in the quality of services. The Dublin government should adhere to the simple principle that everyone has the right to an adequate health service regardless of where they come from or what their income is.