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

I think it's normal to have an itemised receipt. It's a medical bill not a scone.

JoeRoberts said:

Get the job done private for sure but it doesn't have to be in Blackrock Clinic. That is the essence of my point.

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And the "essence" of my point was not The Blackrock Clinic but rather private health care is expensive
I referenced Blackrock because I saw the two invoices from way back in 2014, imagine what that invoice would be today

I'm guessing that private care in other hospitals would be of similar price to Blackrock's in 2014 or even more today,
but I don't know I haven't had the privilege of an over night stay in any private or semi-private hospital
But I know one thing for sure that when the time comes I'll be glad that I do have private health insurance
and will most definitely feel that it's worth it's price compared to not having it and dealing with the public system

You'll be lucky to have the choice. As others have said when the system is busy or has no resources you'll likely be stuffed in public but billed as private.

I'd be interested if it's a factor in outcomes.

Dr Strangelove said:

I went in to a private clinic for a day procedure recently. It was largely covered by my health provider with the balance a co-payment of €40 from me.

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Dr Strangelove said:

Anyway when I went to pay by card I was given a receipt that said something like “medical treatment” in the narrative line.

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When you pay an excess normally you get a receipt to say something like "private health insurance excess" or something similarly generic. This is only for the excess portion.

You should get a copy of the itemised receipt from your health insurer when they get billed for the procedure. This receipt will show the code along with the total cost and an itemised breakdown. When you get this receipt depends on how fast the hospital is to bill the insurance company and how fast they are at processing. It can take anything from weeks to years but usually is measured in months.

AlbacoreA said:

Profit is one thing. What about value for money? Do they care about that.

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To an extent yes. The non profit part doesn't necessarily drive efficiency within VHI but it can within the industry as the other providers now have to match VHI's value proposition and make a profit on top, whilst still competing on price.

VHI do sometimes target a "profit" or surplus, so that they can reinvest it into capital, such as the VHI 360 centres for example. Or so they can make their balance sheet healthier. It also helps offset years where they make an unexpected loss.

When it comes to costs of medical procedures they did/do a lot of work negotiating these. The reason fixed price procedures exist in the first place is so that in "normal" cases the price of the medical procedure is known. This gives some certainty. The alternative to this would be to have all procedure charges on an a la carte basis. So one knee replacement could cost x amount and another patients very similar knee replacement could cost more because the doctor gave them an extra test or deemed and charged for an extra night. Fixed price procedures removed this uncertainty by removing the incentive for hospitals to look for ways to enlarge the bill. If there are complications and additional surgeries or ICU etc are needed the scope of fixed price procedures end and these become billable.

Post recession the private hospitals where looking for ways to drive up demand and be profitable so they cut the prices of procedures. Fast forward to today, the private hospitals are overwhelmed with patients. They can negotiate price increases with the insurers easily in this environment and they do. The insurers have little way to reduce these costs, without simply cutting ties with hospitals which wouldn't help customers. The increase in demand in the hospitals is driving increased claims and this drives increased premiums by insurers.

During COVID VHI gave premium refunds more times than any of the other insurers at the time. As the claims fell more than they forecasted they refunded the difference. The other insurers were forced to follow VHI but they didn't do it as often and wanted to pocket the difference in profit.

I reckon we could open multiple new private hospitals in Ireland tomorrow and they would still all be nearly full such is the demand. Some of this is the blame for the pause in care during COVID. Another factor is a rapidly growing population. Until this gets met with supply and levels out I would expect prices to continue to rise.

Starrynights said:

I reckon we could open multiple new private hospitals in Ireland tomorrow and they would still all be nearly full such is the demand. Some of this is blame for the pause in care during COVID. Another factor is rapidly growing population. Until this gets met with supply and levels out I would expect prices to continue to rise.

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Thanks for the comprehensive and informed explanation @Starrynights Good to know what's going on behind the scenes in health insurance.

Starrynights said:

I reckon we could open multiple new private hospitals in Ireland tomorrow and they would still all be nearly full such is the demand. Some of this is the blame for the pause in care during COVID. Another factor is a rapidly growing population. Until this gets met with supply and levels out I would expect prices to continue to rise.

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We've had a crisis in the health services long before COVID.

AlbacoreA said:

We've had a crisis in the health services long before COVID.

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That's true of public hospitals but it doesn't really apply to private hospitals. Of course it differs between discipline, but broadly speaking there was quite a lot more excess capacity in the private system back in 2019, resulting in shorter wait times for new appointments.

Private hospitals are increasingly relied on by the HSE to help with waiting lists and bed surges. It seems to be an important short term pillar for Sláintecare. Most private hospitals/hospital groups have either expanded, are planning to expand or have made acquisition moves in the recent years which will hopefully help to catch up with growing demand for the private sector.

"....between 1980 and 2015, total inpatient beds decreased by 25.5% nationally..."

While private beds might have increased, its was fraction of what was lost in public beds.

There was always this idea they they were closing down wards and older hospitals to be replaced with new hospitals and facilities that would handle more patients with less beds needed than before. Centers of excellence etc.

Instead what we got was a massively bigger population and net less facilities. This is why people paying for private but ending up in public is so very common.

None of this is recent. I've seen it first hand with family for decades. I know if you dig through the media from way back you'll find it there.

We didn't build more public hospitals during the Tiger years because McCreevy/PD neo liberalism reigned supreme.

Yes but they are two different systems catering for different purposes. Private services really exist to service elective care. It's planned, costed and profitable. People pay for insurance to ensure timely access to elective care.

Unplanned services like true 24/7 A&E care with trauma units, ICU, diagnostics and multiple specialities of medicine doesn't exist in the private system in this country yet. It's likely if they did our premiums would much higher to be more reflective of the averages seen in the USA, were this care is provided privately.

People paying private insurance end up forced to use public hospitals when they need the unplanned services. Or if they are in a position where elective procedures are considered high risk and they need these services available as backup. Then sometimes they may be forced to go public so the doctor has access to these facilities in the same hospital. Otherwise the doctors would have to ring emergency services from the private hospital and wait for an ambulance. Some specific speciality services are also only available in public hospitals.

The private hospitals system really only looks after its own profitablity. If there is demand it can supply for its own profits it will try expand. The HSE and public system is in its own world, where it has tried to reduce its service expenses by a mix of austerity and lack of expansion when demand goes up.

You can slice and dice it many different ways.

My opinion is that overall capacity vs demand is declining over decades. The cost of care is climbing.

A lot of it because its a rudderless ship. When you get consultants advising you how to navigate the layers of bureaucracy and administration to get treatment. You know it's dysfunctional.