VHI, the Irish State health insurer, today warned that if recommendations contained in a report into the way it handles claims were implemented, doctors would lose the right to determine the type of care patients required and it would be transition to a US-style system. The comments were in response to a US consultancy report that was commissioned by Health Minister Mary Harney.
Harney said on Tuesday that the report had found the VHI was paying out too much to hospitals and could make savings of up to 10% if it managed its dealings with them more aggressively.
The VHI said the Milliman Review contains
commercially sensitive information and it is agreeable to the publication of an
agreed redacted version of the report which does not contain this information.
Becoming a US-style utilisation company
will require VHI to invest in and set up significant pre-authorisation
processes, concurrent review processes and post care review processes. Pre-authorisation
would require the consultant treating the customer to obtain VHI’s sign-off on
the proposed care pathway and in the event that VHI did not sign-off, the
customer’s costs would not be reimbursed. Concurrent reviews would involve VHI
staff continuously monitoring the health status of patients to determine whether
they should still be treated and post-care reviews would involve VHI
examining whether the patient should have received the treatment.
Jimmy Tolan, chief executive of VHI said: “VHI faces very significant funding challenges over the next ten years as our customer base continues to age. We anticipate that we will have to deliver significantly more care in critical areas such as cancer, cardiac, orthopaedic and managing chronic conditions. We welcome all constructive inputs including input from Milliman and the Department of Health & Children as we grapple with the challenge of funding our customers’ needs."
If reports would solve the black hole that is the Irish system where wealthy medial consultants straddle the public and private health systems, there would have been a solution a long time ago.
The next minister will likely commission a report from a European consultancy.
What is clear is that the current Health Minister, Mary Harney, will leave office in coming months after a period of over 6 years and a record of failure.
VHI says it currently spends 96% of its customers’ income in meeting the healthcare needs of its customers - - which has required 2011 premium hikes of up to 45%. The key areas of expenditure on behalf of customers are in the following healthcare areas:
© Copyright 2011 by Finfacts.com