Martina Devlin: Peace of mind from health cover comes with forbidding price tag
Should I pay my health insurance or repair the car? Bills for both arrived at the same time, each one for more than €1,000 -- a hefty increase on last year. So, which did I need most, medical cover or wheels?
That was the dilemma I weighed up recently, a variation on predicaments repeated in households nationwide. Should people replace their fridge or meet the creche fees? Pay for the gas or the phone? Is that a leaky roof or was there always a dark patch on the ceiling?
I did the bare minimum on the car to get it through the NCT, before considering my health. How hale and hearty was I feeling? Not bad. How flush was I feeling? Not very.
During the countdown to the policy elapsing, I gloomed about medical cover costs, with a succession of price rises making it twice as expensive as in 2009. It has begun to feel like a luxury, especially since the last two procedures I needed weren't covered so I wound up paying separately for them.
And today, the Irish Independent reports that customers may be obliged to get authorisation in advance from insurers before certain treatments can be carried out.
It's reaching the stage where many people may well conclude they'll take their chances. A policy offers peace of mind. But as hike follows hike, peace of mind comes with a forbidding price tag.
I was veering towards opt-out until I considered the public health system. The care is terrific once you access it, but clicking through the turnstile is the difficulty. The system is creaking visibly, with lengthy waiting lists to consult specialists.
My last encounter with our public health system involved 24 hours on a trolley in a corridor waiting for a bed. When I tottered off to the bathroom, someone pinched my pillow. When I went back to the bathroom several hours later, someone pinched my trolley. The what-ifs of being obliged to rely on public healthcare crowded in on me. From ghoulies and ghosties and long-leggedy beasties and lying on hospital trolleys in the night, Good Lord, deliver us.
Reluctantly, I decided not to number among the 6,000 people a month cancelling private healthcare premiums. Not this year.
Instead, I shopped around for a cheaper deal. It meant changing my policy, probably for the worse -- a statistician would struggle to compare like with like -- but I managed to nudge the bill below my deal-breaker, the €1,000 mark. So the comfort blanket stays in place.
In less than 12 months, however, I'll go through the 'how healthy am I feeling?' routine again. Especially if prices continue their upwards-only trend, for example with a threatened increase to the health insurance levy.
The levy, fixed at €285 but absorbed partially by insurers, accounted for a quarter of my bill. For some, it amounts to 40pc. That's just too much: it was nearly a tipping point for me this year.
Since private healthcare is not a necessity, it is an area where households can make savings. Premium increases are forcing customers out, and will continue to be a deterrent.
Some 2.1 million people currently have private cover but by 2017, the numbers are expected to fall to 1.8 million or so, even with a rising population.
Once, private healthcare allowed people to keep up with the Joneses. Now, fear and not social aspiration is the motivator in persuading people to retain their policies.
But in a society where extravagances are fast becoming rear-view mirror images, private cover is falling into the unaffordable bracket. Soon, fear won't be reason enough.
And two unfortunate results will follow: private healthcare will be more costly for the fewer numbers remaining within its ambit, while additional pressure will be exerted on the public system.
We already know this is no country for the young -- they're jobless or emigrating -- now we can see it will be no country for sick people.
Problems relating to the healthcare sector are rife, but let's consider the levy, since it accounts for such a sizeable element of a customer's private healthcare bill. This charge is shared out among the four insurers to finance risk equalisation: compensation based on their proportion of older, more expensive customers. The meat of it goes to the VHI.
An arrangement which prevents the elderly being charged extra for healthcare is worthwhile in principle, but dangerous cracks are emerging. If something is too dear, customers leave -- simple economics.
The young aren't joining private schemes, while the middle-aged are being priced out. That leaves the elderly. Naturally, they remain: anyone would, in their position. But who will subsidise them if private healthcare becomes a perk only the ultra-wealthy can run to? Even more than I fear reliance on the public system in its current incarnation, I fear yet another divide opening up in society over healthcare.