(Also published in the Cork Evening Echo Tuesday April 26th 2011)

The cost of health insurance weighs heavily on the rebel soul...

The daily assault on our wallets continues to present itself in many forms, and health insurance is no exception. Take VHI’s unforgiving increases for example. Given over one-third of their clientele are on some form of the popular Plan B, a 35-45% premium increase is a bitter pill to swallow for the health conscious Corkonian. Many customers feel that the supposed family-friendly insurer has their backs to the wall. VHI argues that increased claims, rising private bed costs and government levies are to blame. However, less publicised are their misgivings regarding what they deem to be an unfair proportion of older people on the books. Other players of course have also increased premiums, citing similar reasons. Quinn Healthcare has increased by 8-25% and Aviva by 14% since the start of 2011. Lost within these excuses is our sense of community, fuelled by a growing sense of stigma. Older people are now increasingly disfavoured by insurers and the younger population alike, a growing minority of who aggressively blame them for the blitzkrieg of increases. Online forums are awash with rumours that upping the charges on plans popular amongst older citizens are designed to force a mass exodus onto cheaper plans. However, the cure may kill the patient if the haemorrhaging of customers to other providers continues. Even the fortunate who can still afford to access insurance may well find their cover for certain procedures, such as hip and eye surgery, reduced from 100% to 80%. This applies to VHI’s Parents and Kids Plans and First Plans amongst many others in private hospitals.

Dr. Brian Turner, a lecturer in economics at University College Cork (UCC) and a former head of research at the Independent Health Insurance Authority (HIA), advocates a healthy dose of investigation when it comes to renewal time. His expertise means he is a popular man on and off campus amongst worried colleagues and friends. Firstly, he advises looking beyond the glossy brochures to the meat of the plan. What often concerns people above all else is the level of hospital cover – once you decide what standard you are happy with, this should narrow your options down. Secondly, while the opportunity to renew existing cover at the old rates has passed, there is still at least a wide range of choices on offer, with dozens of plans you may never have heard of. Want to sign up to VHI’s mysteriously named PMI 0111? What about Quinn’s Company Health? Have you considered Aviva’s Postbank Level 1 Daily Cover? Despite the group they were originally aimed at, there is nothing to legally stop you from availing of any of the 212 odd plans on the market, if they fit your needs as an individual. The HIA has a wonderful tool on their website that allows you to compare three plans at a time across all insurers (www.hia.ie).

For those in group schemes, renewals will come at different times of the year – as UCC staff discovered this week. All insurers were present on campus to greet a hoard of employees desperate to make the right choice. With five family members to cater for - all on VHI’s Plan B Options policy - a 45 % increase or €2200 extra collectively per annum, certainly got my attention. While Dr. Turner does not advocate any one company or plan, he is personally considering switching from VHI’s Plan B to a lesser known plan called Company Level Plan 1.2. It was quite shocking to discover that small excesses aside, there is little to differentiate the two plans, apart from the price tag per annum (€1429.50 versus €900), and no partial coverage for two private hospitals that we are unlikely to ever be able to afford anyway. It is even superior in some respects, with only a €1 excess for outpatient expenses (versus €250). It must be stressed however that choosing insurance is a highly personal affair – all plans were not created equal. The illogical sense of loyalty many of us have when it comes to insurance, and indeed gas, electricity and banking, must also be stamped out. UCC employee Dr. Paul Bolger subscribes to this mantra. “We want something that will offer good value for the whole family. It was something I had not thought about in a decade until the premiums rose so sharply.” 

A source of comfort to those who can no longer afford the spiralling premiums may be the Hospital Saturday Fund (HSF). They provide what are known as health insurance cash plans, which offer out-patient cover (e.g. dental, optical and GP visits), and include a range of other benefits such as personal accidents and some forms of screening. Plans start from €156 per annum, though realistically a balanced plan will cost €312 to €468 per year. It does not cover hospital stays however (though you may get a small contribution), so it is vital to be aware of this. HSF representative Kay Madden was certainly kept busy fielding queries from the undecided at UCC. “I think people are waking up to the fact that there is an alternative for both the individual and family as a stand-alone option, or as a compliment to their existing insurance.”

The question many want answered is whether the increases will continue. Unfortunately Dr. Turner feels that this is inevitable. “Health insurance prices continue to increase well ahead of inflation. Premiums usually goes up by 8-10% per year, but this was a particularly bad year. Having said that, with universal health insurance coming down the tracks, all bets are off!” Fine Gael’s proposed strategy has been strongly influenced by the Netherlands, who have been using this system since 2006. However Dr. Turner urges caution. “Five years in terms of a health system is a very short time. There is a big risk in terms of potential problems. Few would argue that the Irish system is perfect, but the question is whether this is the right change to make?”

The imminent danger is that as citizens are forced to abandon health insurance altogether, they add to the backlog of a long over-burdened public system. Thirty five-year-old Douglas resident Mick Murphy’s analysis is particularly poignant – “It can be the difference between life and death. A disgusting system we have where patients suffer further illness and death because they have to wait to see a specialist.” The elephant in the room is that considering the ongoing offensive on all areas of Irish life, why are we not rioting in the streets? The two-tiered nature of our healthcare system has never been more apparent. Where is the rebel in the Irish soul?