Watchdog sides with insurers on hospitals charging A&E patients

The state’s insurance watchdog has confirmed that the cost of health claims is being driven up by a government policy that allows hospitals to impose private patient charges on everyone with insurance — even when they end up on trollies because of overcrowding.

The intervention by the Health Insurance Authority (HIA) will be seized on by insurance companies, which are locked in a bitter standoff with health minister Simon Harris over charges.

The insurers claim Harris is using them unfairly to prop up cash-starved public hospitals, even when their customers are entitled to free treatment as emergency patients. Insurers allege their customers are being pressurised to give up their right to free treatment as public patients so that hospitals can bill the insurers up to €1,000 a night for their care.

In its annual report published last week, the HIA said claims costs since 2014 “were probably higher because of the change in the rules for charging private patients in public hospitals in January 2014”.

Claims costs increased by an average of 3% in 2014, by 6.5% in 2015, and by 1% last year.

This appears to contradict recent claims by Harris that the policy shift has not resulted in hospitals passing more of the expense of health care on to the insurance sector.

“The proportion of patients treated privately in public hospitals remained very stable over recent years and did not increase significantly following the introduction of the new charging regime,” said the health minister in reply to a parliamentary question from the independent TD Clare Daly.

The HIA’s annual report also highlighted how insurers were manipulating their policies to make them less attractive to older people, who account for the bulk of claims costs.

Claims made by those in their seventies, for example, averaged more than €3,200 in 2016, compared with €500 for somebody in their thirties.

Even though insurers are legally barred from discriminating on the basis of age, the HIA found that premiums for those over 60 were 34% higher on average than for younger people.

This is because three of the four health insurers in operation last year confined cover for orthopaedic and other treatments associated with older people to their most expensive plans.

The HIA chief executive Don Gallagher has called for a review of the regulation “to reduce the range of techniques through which insurers seek to segment consumers and differentiate product prices by life stage”.

The HIA reported that 46% of the population had private health insurance last year, with the avergae adult paying a premium of €1,177.

The number of individual health plans continues to proliferate, rising to 373 last year from 360 in 2015 and 355 in 2014.

The state-owned VHI remains the market leader, insuring 52% of the 2.1m people with private cover.

Its customers tend to be older, with VHI insuring 66% of those in their seventies who have private cover and 81% of those aged over 80.

Laya Healthcare, owned by the American insurer AIG, has a 27% market share. Irish Life Health, an outfit which resulted from the merger of Aviva and GloHealth, has a 21% share.