# 'Risk Equalisation' set aside by Supreme Court



## redstar (16 Jul 2008)

Quinn Healthcare has won its appeal against 'Risk Equalisation' scheme.

http://www.rte.ie/news/2008/0716/bupa.html

The Supreme Court says the scheme 'is based on a wrong interpretation of the law'.

I wonder what effect this will have on health insurance premiums.


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## theoneill (16 Jul 2008)

Risk equalisation always struck me as a very questionable policy. I guess now the free market will determine health insurance premiums.


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## shnaek (16 Jul 2008)

theoneill said:


> Risk equalisation always struck me as a very questionable policy. I guess now the free market will determine health insurance premiums.



Or else the government will legislate to paper over this inconvenience.


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## redstar (16 Jul 2008)

I suspect thats right, shnaek.
 Risk equalisation, or whatever else they'll call it, will stay in some form or other - the Govt WILL find a way to keep it. They are always very inventive when it comes to making people part with money.


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## NicolaM (16 Jul 2008)

theoneill said:


> Risk equalisation always struck me as a very questionable policy


Why though?
Removing risk equalisation will make it more difficult for vulnerable members of society to obtain health insurance (ie old, sick etc. Could be you or me some day )


theoneill said:


> I guess now the free market will determine health insurance premiums.


But why would this be good?
Using market forces in this manner will lead to a deterioration in health care provision, and not an improvement in standards.
Privatisation in this case leads to 'cherry picking' the patients/cases that will be most cost effective for the company (AKA will involve less payouts for the company).
This is great if you're one of those 'juicy' clients (never sick, never in hospital, never see a doctor) but is pretty bad if you are in a different demographic, as it would become difficult to access health care and increase inequality in the community.
This opinion re risk equalisation is aside from the fact that I personally think having to have private health insurance increases inequity across the board, by the way, as I would be in favour of completely socialised medical care (as a cost of increased taxes, if necessary, but with complete restructuring of the current Irish health care system, as it is currently very inefficient)


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## z109 (16 Jul 2008)

Don't confuse community rating with risk equalisation.

Community rating is the idea that all citizens have equal access to health insurance regardless of age or previous illness.

Risk equalisation is a method of transferring profits made by a company with a lower customer age profile (so a lower risk of claim profile) to a company with a higher customer age profile.

The supreme court has declared the current risk equalisation method unlawful. It has not been asked to rule on community rating.


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## NicolaM (16 Jul 2008)

Is risk equalisation not necessary in order for there to be community rating however?
Remove risk equalisation, and how can community rating (the end point) continue to be viable?


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## z109 (16 Jul 2008)

NicolaM said:


> Is risk equalisation not necessary in order for there to be community rating however?
> Remove risk equalisation, and how can community rating (the end point) continue to be viable?


Yes, but deciding on the source and method of risk equalisation is the question. 

Ideally, in my view, the government should stump up from general taxation since this is for the general good and pay all insurance companies an extra sum for anyone over x age (where x is the defined increase risk age).

This would certainly encourage insurance companies to tout for older person's business.


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## NicolaM (16 Jul 2008)

yoganmahew said:


> Ideally, in my view, the government should stump up from general taxation since this is for the general good and pay all insurance companies an extra sum for anyone over x age (where x is the defined increase risk age).


Excellent point.
I'd agree, except I'd moot for the government use that money to create a effective equitable socialised/publicly financed care system with the money, rather than building up the private health care coffers.


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## z109 (16 Jul 2008)

NicolaM said:


> Excellent point.
> I'd agree, except I'd moot for the government use that money to create a effective equitable socialised/publicly financed care system with the money, rather than building up the private health care coffers.


Ah, if you want my funding idea? An x% tax on every policy taken out (even by the people who will be in receipt of the equalisation payments). So everyone pays in, then the gathered money is divvied out.


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## NicolaM (16 Jul 2008)

yoganmahew said:


> Ah, if you want my funding idea? An x% tax on every policy taken out (even by the people who will be in receipt of the equalisation payments). So everyone pays in, then the gathered money is divvied out.


Ah ha!
We could be coming up with some plans here...
Anyone from Dept. of Health /Government Planning listening?
I always find it frustrating seeing  money being wasted, and services being inefficiently run, when there are many (relatively simple) ways to make systems function more effectively.
Mind you, increasing Health Care efficiency would involve a)culling of staff and b)increased taxes. 
It would involve a courageous government, as neither a) nor b) curry immediate favour, even if they would be the best things to do in the longer term (probably)


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## z109 (16 Jul 2008)

NicolaM said:


> a)culling of staff ... curry immediate favour


You want to kill health staff and then curry them?!!

Well, I'll vote for you then!

(I do agree with you - the Irish health system is very much "I wouldn't start from here").


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## theoneill (17 Jul 2008)

_Why though?
Removing risk equalisation will make it more difficult for vulnerable members of society to obtain health insurance (ie old, sick etc. Could be you or me some day )

_ In that case why not have the same car / house / holiday insurance for everyone. No other area of insurance works like that why should health be different?
It seems to me the government is trying to shoehorn silly solutions to an already broken system instead of just fixing it. Private health insurance is not the answer; it should only be an addition to a high standard of public cover which everyone should be entitled to.


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## rmelly (17 Jul 2008)

yoganmahew said:


> Ideally, in my view, the government should stump up from general taxation since this is for the general good and pay all insurance companies an extra sum for anyone over x age (where x is the defined increase risk age).


 
Surely that would be tantamount to the government admitting that the public health service is a failure - political suicide?


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## jhegarty (17 Jul 2008)

yoganmahew said:


> Don't confuse community rating with risk equalisation.




Why not , listening to newstalk this morning there doesn't seem to be a journalist in the country that knows the difference....


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## ubiquitous (17 Jul 2008)

This is a major embarrassment for Mary Harney, or would have been had her credibility not been shot to pieces already. It has been on the cards ever since the original High Court judgement in favour of VHI in the case brought by BUPA. A child would know that there was something legally dodgy about the State introducing risk equalisation in favour of the VHI incumbent, while at the same time owning that same incumbent. 

Time now for the government to rip up their plans and start again, this time with a proper  universal health insurance scheme.


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## theoneill (17 Jul 2008)

rmelly said:


> Surely that would be tantamount to the government admitting that the public health service is a failure - political suicide?



It may be political suicide but it’s the right thing to do. Further more if the government admitted they made a mistake and made attempts to rectify it they would guarantee my vote in the next election. Bad decisions and mistakes are made every day by everyone, the problems occur when they are not rectified.


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## ubiquitous (17 Jul 2008)

rmelly said:


> Surely that would be tantamount to the government admitting that the public health service is a failure - political suicide?



On the contrary, I think if Brian Cowen admitted this, and set out coherent plans for health service reform, he would get massive support from the public.


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## NicolaM (17 Jul 2008)

theoneill said:


> In that case why not have the same car / house / holiday insurance for everyone. No other area of insurance works like that why should health be different?
> It seems to me the government is trying to shoehorn silly solutions to an already broken system instead of just fixing it. Private health insurance is not the answer; it should only be an addition to a high standard of public cover which everyone should be entitled to.


Because health is different.
You don't need a car, or a holiday, (or at least one could make the argument that you could live without either), however, you certainly at some stage will need access to health care system.
I suspect the reason that people feel forced to purchase private insurance is because they do not trust the public health care system here any longer.
However, your point re private health insurance being in addition to a high standard of cover is spot on.
In the UK (NHS) there is availability of private health care, in addition to the NHS.
It is also un-tenably expensive (£250 (yes, pounds) for a 20 minute standard consultation in a BUPA hospital, paid by yours truly, for example)
The private health care system there is over priced, and to my mind (and from personal experience) no where near as good as public health care.
In addition, there are many concerns there about the 'privatisation' of the NHS, and the negative impact that this will have on the more vulnerable members of society (more cost effective for a private hospital to take an orthopaedic contract on that involves doing knee ops on healthy young people following skiing accidents as opposed to taking contracts that involve  admitting a poorly elderly person that just broke their hip, that also has lots of other medical issues also going on , that will lead to a longer stay, and more cost to treat.) 
It also leads to de-skilling of doctors, and difficulty in training doctors in the future (if you are paying to go privately, would you object if you were seen by a supervised juniour doctor? I think many might). 
You can extrapolate similar problems to here, without the back-up of a relatively efficient NHS behind it (relative to Irish Health care provision, that is)
Improving the public health care system would make much more sense than bolstering up the private health care system (hence my preference for socialised medical care).


rmelly said:


> Surely that would be tantamount to the government admitting that the public health service is a failure - political suicide?


But it is a failure.


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## Purple (17 Jul 2008)

ubiquitous said:


> On the contrary, I think if Brian Cowen admitted this, and set out coherent plans for health service reform, he would get massive support from the public.



The 120'000 people employed by the HSE will not allow the government to implement any real reform.
It can be done; look at the changes that have taken place in the NHS in Northern Ireland. The problem is that the Northern Ireland reforms were very unpopular amongst health care employees (as few people like change and fewer are willing to admit that they are part of the problem) and while they can be pushed through by the UK government our guys just don't have the power to make it happen.

I do agree that a universal health insurance system is the best and most equitable system and I disagree very much with the idea that public funds should be used to subsidise private health insurance.


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## theoneill (17 Jul 2008)

I sometimes wonder if I ever got sick, I mean *really sick* whether it would be better just to hop on a plane to Rennes in France and check myself into a hospital there. Not only would I get world class treatment but I would be surrounded by French nurses.


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## ubiquitous (17 Jul 2008)

NicolaM said:


> Improving the public health care system would make much more sense than bolstering up the private health care system (hence my preference for socialised medical care).




Socialised health care systems are doomed to failure, unless you are dealing with a country like Cuba where doctors and nurses are happy to work for peanuts. We have a socialised public health care system in this country and it is a disaster.  That is why people choose to pay VHI/Quinn/VIVAS for services they can (theoretically) get for free.


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## Sunny (17 Jul 2008)

ubiquitous said:


> A child would know that there was something legally dodgy about the State introducing risk equalisation in favour of the VHI incumbent, while at the same time owning that same incumbent.


 
I don't think the Supreme Court had any problem with that. Their reading was that it was legally wrong under the legisation to apply community rating to the whole population of insured people rather than to individual plans.


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## shnaek (17 Jul 2008)

theoneill said:


> Private health insurance is not the answer; it should only be an addition to a high standard of public cover which everyone should be entitled to.


Hear, hear. Alas our health system is such a shambles, and the only person with the cajones to take it on has turned out not to have had much success.


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## Duke of Marmalade (17 Jul 2008)

This country wants community rating. Under a state monopoly no problems. Under a competitive system required by EU it needs risk equalisation to be stable.

As _Sunny_ says the Supreme Court have simply played clever cloggs. Nothing wrong with RE, but their reading of the Law was that RE applies to plans rather than people, gee why did us ordinary folk and legislators and High Court judges not spot that one? This is absurd nonsense. The Government should simply change the law or better still ask the SC to write the correct words.

If community rating is abandoned it will represent the greatest confiscation of assets since Henry VIII went looking for a few monasteries as holiday homes. A whole generation has paid into the VHI on a CR basis - this effectively means spreading the costs levelly (ignoring medical inflation) throughout your life. This implicitly means paying "too much" when you are young and so building up reserves to be drawn down when you are older. To scrap CR now would be to steal all those reserves from a whole generation.

This system of CR backed by RE works in other jurisdictions, it is not _per se_ unworkable. Either the Government has been careless with the wording of the Act or the SC are simply trying to show how clever and important they are. A system which is so focussed on interpretation of the wording of Acts rather than what was obviously the intention is to me a pomposity. Scrap the Supreme Court.


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## NicolaM (17 Jul 2008)

ubiquitous said:


> Socialised health care systems are doomed to failure, unless you are dealing with a country like Cuba where doctors and nurses are happy to work for peanuts.


Well, NHS docs don't work for peanuts! 
Figures of £100,000 per annum have been bandied about for high earning GPs there! (and regular earners in 70,000-80,000 level)
Cuban health care system excellent, I wish we could transplant it here..


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## Duke of Marmalade (17 Jul 2008)

It is very important to note that the SC did not rule RE unconstitutional. It ruled that the law passed by the Dail did not entitle them to do what they wanted to do. It is purely a legal interpretation of words, not a fundamental point of principle.

Personally I think the SC is simply flexing its muscles letting those High Courts know who best interprets the Law. Its a load of old nonsense for which the taxpayers pay. 

The Dail should pass it over to the SC and ask "please write what we meant", but then that would mean hard work for the SC so no danger of them taking up that challenge.

Harney is a disaster. She is now implying that RE is illegal and so CR must fall. Not at all, simply they didn't write the rules properly.


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## Nermal (17 Jul 2008)

Harchibald said:


> This country wants community rating.



How do you know?

Says a lot that the only form of insurance where it pays to be younger is community rated.


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## Complainer (17 Jul 2008)

ubiquitous said:


> Socialised health care systems are doomed to failure, unless you are dealing with a country like Cuba where doctors and nurses are happy to work for peanuts. We have a socialised public health care system in this country and it is a disaster.  That is why people choose to pay VHI/Quinn/VIVAS for services they can (theoretically) get for free.


It doesnt seen to be a disaster in the Uk where just 10% feel the need for health insurance.


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## Duke of Marmalade (17 Jul 2008)

Nermal said:


> How do you know?


That's what the Dail voted for. But maybe you're right, subject to a referendum Dana would probably get a "No to CR".


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## Duke of Marmalade (17 Jul 2008)

Nermal said:


> Says a lot that the only form of insurance where it pays to be younger is community rated.


VHI has operated as a combination of an insurance policy and a savings policy. People have paid too much when they were young so that they were "saving" for when they get old. If community rating is abolished, the very least that society owes to those who have made such savings is that their future contributions will be reduced to recognise these savings.

This won't happen. We are a CR society. The government have to tighten up the law to enable RE, get the SC to write the rules if necessary. And BUPA should be made to pay for their opportunistic attack on our system.


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## shnaek (18 Jul 2008)

CR is essential for the government to continue to pass of the extra taxation that is private health insurance as some sort of benefit so we all pay for it. Without CR more people would go public, and that would be a disaster for government, as well as being unpopular. They'd have to increase the 'health levy', another load of nonsense from the 'servants' of this country. Call it what it is, a tax. 
We should ask ourselves this: If we all refused to pay private health insurance, what would our government do?


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## redstar (18 Jul 2008)

Surely the real scandal here is with the  elderly having to rely on private health insurance to get good quality health-care. The Govt is hiving off its responsibility to look after the most vulnerable onto private insurers and yet accusing the private insurers of wanting to cherry-pick its customers.

Why does VHI have so many older customers ? No surprise, given that for years they were the only insurer in a non-existent market.


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## Duke of Marmalade (18 Jul 2008)

redstar said:


> Why does VHI have so many older customers ?


Wrong question. VHI probably has or had a fair cross section of the population.

The question is _"why did BUPA *not* have many old customers?_" After all they were community rated and they were cheaper. The answer is clear; BUPA targetted the young, despite claiming to be open to all. It was exactly this cynicism that RE was meant to tackle. Somehow our legislators messed up the wording. It is absolutely galling that BUPA might get away with their cynical gamble that the legislation, which they were fully aware of, wouldn't stick.


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## redstar (18 Jul 2008)

I suspect many older people just did not bother to switch to Bupa. Customer inertia and loyalty is a well known factor, not just in health - many people don't bother to switch bank accounts even though better value may be had elsewhere.

How did Bupa 'target younger people' ? They advertised their products publically - everyone was equally aware of what they offered and their costs. Why did older people not switch ?

VHI would have built up a large customer base (100% at one stage) over the years so its only natural that their age profile would be older than newcomers.


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## GSheehy (18 Jul 2008)

I don't think it fair to lay the blame for the age profile of members at the door of other insurers, only.

VHI have been loosing its younger customers for years and as far as I can see they have done nothing to invite them back. Can anyone here recall being actively marketed by VHI after switching from them?

It's probably easier to sit on your hands and do nothing as opposed to developing into the efficient and innovative company that flourishes in a non monopolistic market. 

They have no defence for their higher premiums, when questioned, except for to say that their age profile is higher than their competitors, which means higher pay outs.

If they seriously wanted to offload the higher risks to other insurers they would not make it so difficult for them to leave, by creating a doubt in the minds of the gullible that they would in some way be getting an inferior product. They want all the customers, but on their terms.

The relative efficiency, in terms of cost base, of the different insurers is anyone’s guess but I would bet that the new kids on the block are a dab hand better at it than VHI.


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## Duke of Marmalade (18 Jul 2008)

Okay we all agree that competition is better than monoploy. But with CR the easiest way to compete is to target the obviously healthier sections of the community, in fact money for old rope and didn't BUPA spot a good thing. Competition which favours the best cherry pickers adds nothing to society. Competition which encourages efficient administration is a good thing. But without RE the cherry-picking type of competition would dominate the efficiency type. VHI were due very large sums from BUPA and that had nothing to do with BUPA being more efficient, it was purely cherry picking.

Interesting question whether motor insurance should be community rated as in New Zealand. The difference is that there is a certain fault which attaches to high risk motorists and risk rating helps control behaviour. However, I wouldn't dismiss CR for motor insurance out of hand especially when many "innocent" young male drivers are clearly being outrageously charged for the "sins" of a few.


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## redstar (18 Jul 2008)

I still haven't seen any evidence to show how Bupa (or Vivas) have been 'cherry-picking'.

All I can see is the dominant, state-backed insurer taking money off its competitors, under RE.


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## Duke of Marmalade (18 Jul 2008)

I don't think you fully understand RE. What happens is that the market is taken as a whole and the chances of being in hospital and the average duration of stay is calculated for the whole population.

Then each companiy's results are restated as if the chances of being in hospital and the duration of stay were the same as the market average. The argument is that there is nothing a company can do to actually affect these chances, it is a matter of luck or more likely having deliberately targetted the more healthy lives. Make no mistake BUPA does not make you healthy but strangely people with BUPA are healthier than those with VHI 

If BUPA had "averagely" healthy lives it would have made much less profit and so under RE it needs to give that unearned and undeserved "profit" over to VHI.

All other aspects of the company's performance such as admin efficiency are not equalised, but these are really small beer compared to the huge difference in risks between young and old.


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## redstar (18 Jul 2008)

Oh I understand RE alright. Its an idealised mechanism which only works on a level playing field.
Imagine a market with no health insurers. Then three insurers arrive. Their market shares should be distributed roughly equally and with the same healthyness distribution that you mention. If any of them were cheaper/more efficient, they might pick up a higher proportion of customers.

In reality we started with one insurer who already had 100%  of the market.
Then, newcomers arrive - what happens to the existing insurer ? Do customers leave in equal proportion across all ages to the newcomers ? 
I doubt it. 
Older, less healthier, customers who may have been with them for decades tend to stay, whereas younger ones move.
In addition, first-time customers look at the health providers products and decide VHI is too expensive and they join Bupa/Vivas.

It'd be interesting to look at the distribution of first timers in each health-insurer, and ask why they do not join VHI.

The upshot of all this is that the market is _skewed_ because for years there was only one insurer. Effectively,the 'unhealthier' portion stay with VHI.

Over time, this effect should lessen and the other insurers should eventually have a similar distribution to VHI. But only IF VHI make themselves more competitive and stop using RE as an excuse not to become more efficient.

There are lots of factors affecting the type of market share that an insurer has. 
Lumping them all under 'cherry-picking' does not help to understand those factors.


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## Duke of Marmalade (18 Jul 2008)

_Redstar_, do you accept that RE is necessary for the stability of CR?


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## redstar (21 Jul 2008)

No.
RE is a blunt instrument which actively discourages entrants into the market.
RE distorts the market in favour of the longer established encumbants.

I would prefer a strong national health system, enough to dissuade people from thinking they require private health insurance.
We do not have such a system, so the gap is filled by the private sector - who are then told they cannot compete properly in a market which was created because the state has failed to deliver adequate health services.


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## MOB (21 Jul 2008)

There is a simple solution to this problem.  Re-assign blocks of people from the older demographic until the risk profile of the new insurers matches that of the older ones.   I would see nothing wrong with a situation where people over 50 are automatically re-assigned to a new insurer (with an 'opt-out' right).   After all, it is only inertia keeping many of them with VHI.  

Why, I wonder, have VHI not canvassed for this approach to be taken?


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## redstar (21 Jul 2008)

MOB said:


> There is a simple solution to this problem.  Re-assign blocks of people from the older demographic until the risk profile of the new insurers matches that of the older ones.   I would see nothing wrong with a situation where people over 50 are automatically re-assigned to a new insurer (with an 'opt-out' right).   After all, it is only inertia keeping many of them with VHI.



Sounds sensible, alright. 'Older' people could be asked at renewal time and explicitly shown the breakdown of equivalent plans from all insurers along with price, and asked if they want to switch.



MOB said:


> Why, I wonder, have VHI not canvassed for this approach to be taken?


Easier just to take large payouts from the competition.


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## room305 (22 Jul 2008)

NicolaM said:


> Cuban health care system excellent, I wish we could transplant it here..


 
Are you making this statement based on an intimate knowledge of the Cuban medical care system, or just the propaganda from a dictatorship?

It's something of a truism on Internet message boards discussing medical care that someone will mention how "great" the Cuban medical system is and how well the Western world would do to emulate it.

If you wanted to be treated by doctors working round the clock for less than the average taxi driver because they're worried what will happen their family if they don't show up for work, then fine, apply for a Cuban visa. But pray don't wish such a miserable existence on others who happen to have had the good fortune to be born into a democracy.


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## MOB (22 Jul 2008)

"Are you making this statement based on an intimate knowledge of the Cuban medical care system, or just the propaganda from a dictatorship?"

I don't think it's quite as black and white as all that.  Even a cursory web search will turn up commentators who have no truck with the socialist model, but who nevertheless have some admiration for what has been achieved in Cuban healthcare.

http://www.hsph.harvard.edu/review/review_summer_02/677cuba.html


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## Purple (22 Jul 2008)

room305 said:


> Are you making this statement based on an intimate knowledge of the Cuban medical care system, or just the propaganda from a dictatorship?
> 
> It's something of a truism on Internet message boards discussing medical care that someone will mention how "great" the Cuban medical system is and how well the Western world would do to emulate it.
> 
> If you wanted to be treated by doctors working round the clock for less than the average taxi driver because they're worried what will happen their family if they don't show up for work, then fine, apply for a Cuban visa. But pray don't wish such a miserable existence on others who happen to have had the good fortune to be borne into a democracy.


 Well said. A totalitarian dictatorship can impose any system it wants.


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## room305 (23 Jul 2008)

MOB said:


> "Are you making this statement based on an intimate knowledge of the Cuban medical care system, or just the propaganda from a dictatorship?"
> 
> I don't think it's quite as black and white as all that. Even a cursory web search will turn up commentators who have no truck with the socialist model, but who nevertheless have some admiration for what has been achieved in Cuban healthcare.
> 
> http://www.hsph.harvard.edu/review/review_summer_02/677cuba.html


 
Whether they have "truck" with the socialist model is open to debate but you cannot ignore the fact that their "miracle" system is only made possible through virtue of being a dictatorship. Doctors can be made to work for a pittance (hence the high doctor-to-patient ratio) and health officials can indoctrinate and bully the general populace into adopting lifestyles that are less likely to see them end up in hospital.

Seriously, it's like admiring the education system in North Korea because the kids are too scared not to study hard.

From the linked article:



> A functional blend of public health and medicine, Cuba's commendable health care system is nevertheless a product of a socialist revolution--so whether its methods can be feasibly applied to the United States remains an open question ... One of the most controversial of Cuban health programs has been the sanatorium-based care for AIDS, which originally obligated all HIV-positive patients to live out the rest of their lives in these small clinic-based communities. Today, an outpatient option is offered to those who qualify, but many patients don't take advantage of it because they are often ensured better care in the sanatoria. "Really, what we have is a conflict of ideology--the conflict between personal freedom and public health," notes Cash. "What works for Cuba may not work for us."


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## csirl (25 Jul 2008)

> Quote:
> Originally Posted by *NicolaM* http://www.askaboutmoney.com/showthread.php?p=671665#post671665
> _Cuban health care system excellent, I wish we could transplant it here.._


 
If Cuban health care is so good, then how come they have a low life expectancy?



> How did Bupa 'target younger people' ? They advertised their products publically - everyone was equally aware of what they offered and their costs. Why did older people not switch ?


 
Here's one example of how Bupa targeted younger people.

May of the US multinationals in Ireland have private health insurance as part of the package of benefits to employees. These companies tend to have young workforces. Bupa targeted these companies and did deals to become the designated health insurance provider and in doing so acquired significant numbers of young and healthy members.


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## shnaek (25 Jul 2008)

csirl said:


> Here's one example of how Bupa targeted younger people.
> 
> May of the US multinationals in Ireland have private health insurance as part of the package of benefits to employees. These companies tend to have young workforces. Bupa targeted these companies and did deals to become the designated health insurance provider and in doing so acquired significant numbers of young and healthy members.



Why didn't VHI offer these deals then? In fact Dell and EMC both use VHI for this purpose - and they are only 2 I have personal experience of.


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## redstar (25 Jul 2008)

I work for a major US multinational and both VHI and Bupa/Quinn are available to us.
Previous US multinationals I worked for only offered VHI in pre-Bupa days. So why are VHI losing what was a previous captive audience ?


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