Actuaries group warns insurers may need up to €2.4bn for UHI plan

Actuaries have warned the Government that insurers could need between €1.6 billion and €2.4 billion in additional regulatory capital to operate a system of universal health insurance (UHI).

In its submission to the Department of Health on the Government 's plans for UHI, the Society of Actuaries in Ireland said one of the main omissions was any consideration of the regulatory capital consequences for health insurers of moving to the new system.

“The total level of regulatory capital required by insurers to operate a universal health insurance system in Ireland will be very substantial. We estimate that the additional regulatory capital required could be between €1.6 billion and €2.4 billion,” the society said.

“While currently unclear, it is plausible to believe that somewhere in the range of 50 to 80 per cent of direct exchequer spending (€12.8 billion for 2014) could be redirected to insurers under universal health insurance. Insurers will be required to set aside regulatory capital for the insurance cover being financed by these monetary flows.”

No clarity

Social Justice Ireland said there was no clarity as to what would be contained in the core basket of services to be covered under UHI. It said there was an inherent danger that discrimination could occur for some groups with rare diseases or that those covered by the long-term illness scheme could be vulnerable in the new “commissioning approach”.

Employers’ group Ibec also said it was concerned at the absence of detail on key issues such as the precise services and medicines to be included in the basic universal health insurance health basket and the estimated costs for citizens, business and the State.

The Irish Medical Organisation said the "implications of the system as outlined will restrict choice and lead to rapid closures of smaller health facilities throughout the country due to economies of scale creating additional inequity".

‘International evidence’

The

Irish Pharmacy Union

said there was “clear international evidence” to show that schemes that were controlled by insurance companies had led to a reduction in the number and range of medicines that are accessible.

"The IPU would also be extremely concerned that a situation could arise, as is the case in the United States, that insurance companies could dictate to patients what pharmacies they could purchase their medicines from and also dictate co-payment terms."

State-owned health insurer VHI said that while a one-tier health system with equal access for all seemed like an egalitarian approach, unless more infrastructure such as additional GPs, primary care and step-down facilities were made available, “the likelihood is that universal health insurance will provide improved access for the uninsured but a disimprovement for those who for decades provided for their own healthcare through private insurance”.

The Society of St Vincent de Paul said it was concerned that the risk of an upward-only price structure would be impossible to finance for those on insecure incomes.

The Irish Association of Speech and Language Therapists said there was a "potential risk that services not Government-funded . . . will become second tier".