A review of community-rated health insurance has been called for by the former chief executive of the VHI, Mr Brian Duncan. Addressing a seminar organised by the Society of Actuaries in Ireland this week, Mr Duncan said the introduction of a higher premium for people who wait to take out health insurance until they are older should be examined.
Mr Duncan, now an actuarial and business consultant, outlined policy options on the future financing of health care. Speaking about the fairness of the healthcare system, he said the level of expenditure was broadly in line with other countries in terms of GNP. Ireland was "lagging behind", he said, but getting better.
"However, there are legitimate questions to be raised regarding the fairness or equity of the system." He said it was difficult to decide what was fair but asked if there should be a two-tier entry system to public hospitals. He drew an analogy with access to university education.
"Imagine the outcry if UCD announced tomorrow that they were making an additional 2,000 places available in the most popular subjects but that these would be allotted, not on points, but on the payment of a fee of £500 per term. Yet is this not how private health insurance works? I see no difficulty with providing preferential accommodation or other facilities once access has been achieved."
He said a single-entry system would require a major investment to reduce waiting lists to a more acceptable level. Mr Duncan said a variation on retaining the present structures of the health-care system would be to introduce full economic charging for public hospitals, with some financial compensation to avoid large once-off premium increases and to introduce age-at-entry community-rated premiums.
He highlighted the absence of "any serious attempts" to measure the effectiveness of the considerable expenditure involved in health care.
"Traditionally, Irish ministers for health when asked about health care have focused on the number of new beds opened or the number of additional consultants appointed. However, by and large the effectiveness of various treatments is much less measured. Sometimes I wonder if it is because as consumers we might not like the results."
A controversial problem was that all private care was financed on a fee-for-service basis. "Inevitably this means the treatment is more on service than on prevention. I feel there is a case to be argued that the overall system of health care would be better served if all those involved in providing care were on a fixed salary. I want to emphasise that I am not suggesting that income levels are too high."