Health Insurance At what point does private health insurance simply become uneconomical?

arbitron said:
Public hospitals are entitled to charge private insurers when an insured patient is admitted. If they fail to ask patients to sign the insurance form then they are throwing away money from the public purse. That would be a serious breach of their fiduciary duty to public patients and to the taxpayer. If the insurers and customers want to change the rules then they should lobby government and the Department of Health.
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Hi @arbitron,

Don't think its quite as simple as that. Insurance Ireland appear to explain the situation quite well here. Its probably one of the very many reasons why private health insurance is financially beyond a lot of family's reach and it would appear to be getting worse as the years go by.


Health Insurance & Public Hospital Access​


Following the introduction of the Health Amendment Act 2013, health insurance customers are charged a private rate for public treatment in public hospitals when admitted through Accident and Emergency. To allow for this, patients are being asked to sign a Private Insurance Patient Form which means they waive their right to treatment as public patients.

1. What is it?

Patients who are admitted to a public hospital through A&E with Private Health Insurance are being asked to sign a Private Insurance Patient Form (image below) which asks them to waive their right to public treatment in a public hospital.

2. What should I do if/when I am presented with the form?

Patients are being presented with a choice and health insurance holders should ask what additional services they are getting by using their health insurance above the public treatment they are already entitled to.

If you have health insurance and you do not sign the form, you will not have to pay the bill for your public treatment. Your health insurer will cover the public charge for your stay in the public hospital.

If you are satisfied that you are getting additional services as a result of private treatment (e.g. a semi- private room) before signing the form.

3. How does it affect me?

Premiums are a function of claims costs. If you choose private treatment your health insurer will be charged €813 per day. If you choose public treatment your health insurer will be charged €80 per day.

Since the introduction of this charge, it has increased the total cost of claims by approximately €200 million. The impact is far more than the original estimate by the Government of €45 million.

4. Do I have to sign the form?

You should ask – Can I be guaranteed a private or semi-private room or that you are getting an additional service? Remember if you do not have a guarantee, you have the right to say no.

5. Does not signing the form impact on the treatment I will receive?

We advise that you satisfy yourself that you are getting additional services as a result of going private (e.g. a private room). In many cases, there is no difference in care provided the amount charged to your insurers is over ten times the public rate.
 
The missus got a new hip six months ago. Laya paid for it. Cost them €16k. Cost us €240 (after the 20% tax relief)

She'll probably get the other one done next year.

Then it will be my turn, the big decision being whether to get a new knee or a new hip first. 4 hips at €16k is a lot of money. A pair of knees are probably in the same ballpark. Thanks LAYA!
 
Marsupial said:
The missus got a new hip six months ago. Laya paid for it. Cost them €16k. Cost us €240 (after the 20% tax relief)

She'll probably get the other one done next year.

Then it will be my turn, the big decision being whether to get a new knee or a new hip first. 4 hips at €16k is a lot of money. A pair of knees are probably in the same ballpark. Thanks LAYA!
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Come on - leave a few for the rest of us!
 
Marsupial said:
your bits may wear out!
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:oops:

Marsupial said:
The missus got a new hip six months ago. Laya paid for it. Cost them €16k. Cost us €240 (after the 20% tax relief)

She'll probably get the other one done next year.

Then it will be my turn, the big decision being whether to get a new knee or a new hip first. 4 hips at €16k is a lot of money. A pair of knees are probably in the same ballpark. Thanks LAYA!
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AXA may yet regret that takeover of Laya.
 
Marsupial said:
The missus got a new hip six months ago. Laya paid for it. Cost them €16k. Cost us €240 (after the 20% tax relief)

She'll probably get the other one done next year.
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What age is she and what age did she first take out health insurance?

"The prevalence of total hip replacement at fifty years of age was 0.58% and increased to 1.49% at sixty years, 3.25% at seventy years, 5.26% at eighty years, and 5.87% at ninety years of age. The prevalence of total knee replacement at fifty years of age was 0.68% and increased to 2.92% at sixty years, 7.29% at seventy years,"

this from US statistics and US probably higher than other countries in Europe
 
Marsupial said:
I resisted the urge to tell everyone about my impending shoulder replacement! Moral: if you play rugby when you're young, your bits may wear out!
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I think GAA is worse for getting hip and knee replacements at very young age. The GAA wouldn't be flush with cash if they had to pay for all the joint replacements of former players after they retire
 
arbitron said:
Public hospitals are entitled to charge private insurers when an insured patient is admitted. If they fail to ask patients to sign the insurance form then they are throwing away money from the public purse. That would be a serious breach of their fiduciary duty to public patients and to the taxpayer. If the insurers and customers want to change the rules then they should lobby government and the Department of Health.
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I was asked to sign a form so that my insurer would pay for treatment which was 100% identical to what I was receiving in the public system. I refused.

I would personally describe this as “attempted fraud”.
 
The main sentiment is something I think we all look at. Myself and my other half are average earners and this year our renewal with Laya was over 5K. I have to nark at himself to even get his bloods done, he does not have a single filling really has good health but I have not considered downgrading or cancelling. My kids have some extra needs and I have them on VHI. This year was more financially challenging for us and for the first time in my life we are paying monthly I just did not have the 5.5K to pay in a lump sum.

I am more concerned in my 50’s about having high tech and ortho cover I had an Echo and some bits done with a consultant in the Mater Private that was a learning experience. In future for any diagnostics I will find a centre that has direct payment with Laya. My son recently needed an MRI of his nose and he is with VHI Smithfield accept VHI but not for minors. Affidea do but nothing northside made enquiries and went to Dundrum for direct payment. With my Echo it was not direct payment so I could only claim 50% back I had gone through the emergency A + E in the Mater which was capped at 400E. Separate referral to a cardiologist another outpatient claim and private blood work is ferociously expensive. I ended up going over my outpatient cap it was a learning curve for me.
 
joe sod said:
What age is she and what age did she first take out health insurance?
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We're in our mid-60s and we first took out cover (with Glohealth) about 15 years ago.
Dr Strangelove said:
I was asked to sign a form so that my insurer would pay for treatment which was 100% identical to what I was receiving in the public system. I refused.
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In other words you chose to deprive the Exchequer of revenue in order to enhance the profitability of a private sector company. If I was a shareholder in said private company, then I'd regard you as a hero.
 
Marsupial said:
We're in our mid-60s and we first took out cover (with Glohealth) about 15 years ago.
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You have already paid for your treatments through your premiums and you are still in a minority by needing hip replacements in your 60s , you were a rugby player which increased your needs for joint replacements so in your case it was worth getting health insurance. I wonder do they ask that on your health insurance whether you were involved in contact sports?, surely that would increase the risk for the health insurer?
 
arbitron said:
That would be a serious breach of their fiduciary duty to public patients and to the taxpayer.
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Anybody who arrives into A&E in a public hospital is entitled to be treated as a public patient. We all pay our taxes. Having private health insurance allows you to choose health care outside of the public system. You can certainly choose to sign the form and have the health insurance company pay the hospital but you won’t get special treatment or any different level of care. The tax payer (us) is paying the full cost of the hospital even if no patients show up.

I am not surprised the finance people in the public hospital think the private health insurance people are cash cows, but their fiduciary duty should be focused on efficiencies and the reduction of wasteful practices, to ensure the taxpayers money is well spent.
 
Sue Ellen said:
Don't think its quite as simple as that.
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I think the story is straightforward. The law changed several years ago allowing public hospitals to charge insurers €800+ per night for private patients treated in public beds.

Everyone here agrees that it's a ridiculous system but it is wild to suggest that public hospitals should decline money to which they are legally entitled. If a hospital board found out their CEO/CFO chose to ignore this potential revenue there would be war.

I can't find any evidence that these charges are a significant factor in higher premiums. Even with the extra €200 million that the insurers claim they pay they are still making large profits.

Clamball said:
I am not surprised the finance people in the public hospital think the private health insurance people are cash cows, but their fiduciary duty should be focused on efficiencies and the reduction of wasteful practices, to ensure the taxpayers money is well spent.
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It's not the finance people in the public hospitals, it's the government. They wrote the law specifically so public hospitals could charge these fees. Yes, it is effectively a stealth tax on private insurers, but the public hospitals can't go rogue and just decide not to pursue the revenue. Talking about taxpayer money being well spent while also expecting hospitals to leave €200 million of private money on the table is contradictory. The insurance companies should get better lobbyists if they want to change the rules.

The only way to address all of this mess is to fully implement Slaintecare and move to a true universal healthcare system agnostic of personal means. Then the OP and everyone else could enjoy much lower bills and there would be less queue jumping.
 
arbitron said:
The only way to address all of this mess is to fully implement Slaintecare and move to a true universal healthcare system agnostic of personal means. Then the OP and everyone else could enjoy much lower bills and there would be less queue jumping.
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Totally agree with you about universal health care. I haven’t heard of anyone queue jumping in the public system for a long time, even if the public patient has private health insurance. Only the sickest get fast tracked.
 
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