VHI plans for over-65s carry health warning

Subscribers must look closely at what private insurance has to offer as they grow older

LAST WEEK’s suggestion by the Voluntary Health Insurance chief executive to the Business Affairs Correspondent of this newspaper that it become the provider of medical insurance for the over-65s must have caused considerable indigestion at breakfast tables around the country.

Jimmy Tolan said he wants the VHI to become a US-style Medicare entity, to which older people would pay a premium depending on the level of care they receive. Can this be the same body which this year targeted its biggest category of insurer (those in Plan B) with a selective 45 per cent rise for policies renewed from February 1st?

Since its inception, the clear understanding was that VHI customers who stayed with the insurer through their lifetime would not face exorbitant premia as they aged and their health needs increased. The principle of community rating was seen as a non-negotiable sine qua non of private Irish healthcare. However, that has now been swept aside in what appears a calculated move by the VHI to rid itself of customers aged over 65.

Less than three months later, we are being asked to consider a proposal that the VHI (or at least part of it) should become the specialist provider for this age group.

Let’s look at its track record in providing services for older people. As an organisation that excels at providing cover for big ticket procedures such as hip replacement and coronary artery bypass surgery, many insured older people benefit. However, a growing number of over-65s in the Republic are living longer and developing a greater number of chronic diseases than heretofore, a trend that is set to increase in tandem with medical advances in the future.

A 75-year-old is likely to have a combination of common ailments such as cardiovascular disease, arthritis and a chronic neurological condition.

Take stroke care as an example. Some 10,000 people develop a stroke here every year. Almost 60,000 people are survivors of an acute stroke, but live with the consequences for the rest of their lives. The Irish Heart Foundation has recognised their largely unmet rehabilitation needs by initiating a study on the cost of stroke rehabilitation. However bad the situation in the public health system is, it is so much worse in the private sector.

A person suffering a stroke and cared for in a private hospital will find that in many cases, essential elements of stroke unit care are not available to them. The main reason for this is that private hospitals are not reimbursed by insurers for employing health professionals such as speech and language therapists and occupational therapists.

After leaving hospital, VHI plan B members receive up to €13 per visit for a maximum of 12 assessments and treatments a year by a combination of speech therapists, occupational therapists, dieticians and clinical psychologists. With most of these professional encounters lasting between 30 minutes and an hour, the benefit is derisory; the bulk of the cost must be met from the insured’s own pocket.

What can the VHI offer you when you need specific appliances to maximise your independence after a stroke? Plan B members may claim a maximum of €3,200, minus their excess, towards the cost of a wheelchair. A powered wheelchair will cost you somewhere between €4,000 and €9,000. However, there is no assistance available for the other aids and appliances likely to be recommended by a therapist for a stroke patient.

Nowhere is a team approach to stroke care facilitated or encouraged by the VHI. In effect they are discouraging best clinical practice by their schedule of payments. To put it bluntly, if as a VHI member you choose to be treated for a stroke in the private hospital sector, you are effectively choosing a lower level of care which is likely to increase your residual disability after the acute event.

Could the Medicare proposal simply be a recent recommendation made by management consultants Milliman dressed up in a new suit of clothes? The US firm’s report into the health insurer’s cost base floated the idea of the VHI becoming a US-style healthcare utilisation company. Also known as healthcare managed organisations (HMOs), many have a track record of denying patients medically prescribed treatments. If this is what older subscribers have to look forward to from a revamped VHI, then there can only be one response to Tolan. No thank you.

Even now, individual subscribers struggling to pay rising health insurance costs need to look closely at what private insurance has to offer them as they grow older: for some it may not make sense to continue. And if the VHI is serious about becoming an Irish Medicare, then it needs to bring “older age friendly” insurance plans to the market without delay.

Dr MUIRIS HOUSTON

is health analyst for

The Irish Times

; Noel Whelan is on leave