IHAI seeks role in UHI design

The Independent Hospitals Association of Ireland agreed with the principle of Universal Health Insurance, but was concerned that there had been no engagement of the independent sector in the design or planning of the scheme to date, Ms. Catherine Whelan, Chief Executive of the IHAI told the Conference.

The Independent Hospitals Association of Ireland was fully supportive of the principle of Universal Health Insurance, but was concerned that there had been no engagement of the independent sector in the design or planning of the scheme to date, Ms. Catherine Whelan, Chief Executive of the IHAI told the Conference.

Ms. Catherine Whelan, Chief Executive of the IHAI
Ms. Catherine Whelan, Chief Executive of the IHAI

She said the IHAI – which is the representative group for the independent hospital sector in Ireland and represents 21 independent hospitals providing acute and mental health services – was supportive of all reforms that improved the quality of healthcare provision. It agreed with the principle of UHI, that patients would have access to a high quality, affordable service on the basis of need, not ability to pay.

Speaking on “Alternative Models” she said: “We would like to bring our resources and expertise to bear to deliver healthcare reform.”

There was movement to a single tier health system without involvement of one of the current tiers, which had significant experience of costing and pricing.

Ms. Whelan said the IHAI’s understanding was that every citizen would be insured for a “standard basket” of health services, there would be no option for insurers/providers to sell faster access to services, there would be no distinction between insured and uninsured patients, universal care would be provided through independent not for profit trusts and private hospitals and there would be a multi payer model with competing insurers.”

Ms. Whelan said that the IHAI was concerned that there had been no engagement of the independent hospital sector with the planning for UHI to date.  It had not been included in the UHI Implementation Group or the Health Insurance Forum.  This meant that there was movement to a single tier health system without involvement of one of the current tiers, which had significant experience of costing and pricing.

There were uncertainties and risks in introducing structural change in a contracting fiscal environment, significant upfront cost, a very ambitions timetable and significant interdependencies/deliverables. With the Dutch System costing 12 per cent of GDP, the question had to be asked if UHI would achieve the promised cost control.

There was the question of an unstable private health care insurance market in the medium term and the sustainability of the independent sector in the interim.

“The current ‘two tier’ system serves no one well, particularly patients.”

The perspectives of all stakeholders needed to be considered and pricing mechanisms must reflect the full economic costs e.g. capital, pensions etc.

The IHAI believed that a high performance health system should provide patients with easy access to quality services at an affordable price.

The Association members operate almost one third of Ireland’s acute hospitals, provide 1 million bed nights per annum and one in six of available hospital beds, care for 400,000 patients per annum (one in every five), complete 250,000 theatre procedures and 3 million diagnostic tests each year.  Members also provide 22 per cent of all mental health care treatment, 50 per cent of all open heart surgeries and 65 per cent of all spinal surgery and directly employ 8,400 staff across the country.

To qualify for IHAI membership, a hospital must be in the independent sector, provide acute medical, surgical or psychiatric inpatient services and be accredited by an internationally recognised accreditation body.

Ms. Whelan said that the IHAI played a key role in introducing leading edge technology/expertise such as PET, CT, Cardiac CT, MRI, Transcatheter aortic valve implantation (TAVI), Linear Accelerators, Stereotactic radiosurgery, Renal artery denervation, multi specialty robotic assisted surgical programmes, minimally invasive mitral valve repair and prostate radioactive seed implantation.

She said the challenges to independent hospitals were the unstable private health insurance market, underutilised capacity, reduced procedure prices paid by private health insurers, a medical manpower challenge and the fact that it had no role in national healthcare reform.

“The current ‘two tier’ system serves no one well, particularly patients. There is no integrated approach to resource/capacity planning, there is an underutilised independent sector capacity and an overburdened public sector, a lack of opportunity to share best practice, efficiency, innovation.  A balance of collaboration and competition is possible and would be positive for patients”, she said.