Sir, – I am amazed that in the debate on the cost of health insurance there is a disjuncture between it and medical fees and charges. These fees and charges represent by far the highest element of premium costs, exceeding both Government taxes and levies and the profits of insurance companies. But it is the premiums that are constantly criticised without any reference to fees and charges which seem to be implicitly accepted by all.
There was an effort to cut back on fees in the public sector in conjunction with Croke Park. There was no similar effort with private fees. Salaries and wages of most people have been cut, but when you go to a GP or specialist you still have to pay around €60 and €150 respectively.
Even if they had been cut back in line with Croke Park, private costs would still be too high either objectively or compared to other countries. I have extensive experience of both the Irish and Belgian systems and here are three standard examples: 1. Visit to GP: €32 in Belgium as opposed to €60 here (187 per cent). 2. Visit to consultant: €65 as opposed to €150 (250 per cent). 3. Simple dermatological excision: €140 as opposed to €700 (500 per cent). Differences of this order are indefensible.
I have queried the level of fees with medical practitioners and they raised the usual arguments about overheads and in particular the costs and rules of professional indemnity insurance. I pushed one specialist on these details many years ago. In his frustration he asked what I expected him to charge in the light of the earnings of lawyers and accountants. I had no answer to that.
I previously drew this matter to the attention of politicians, the media and the Irish Patients’ Association with the suggestion that pending a review of fees people should unilaterally reduce their premium payments in line with public service cuts. That was perhaps too radical.
While the troika was here the Government had the perfect cover for taking direct action on fees in the largely self-regulated professions. That they did not do so shows the perceived strength of the professions at political level. This is further reflected by fact that we seldom if ever see any sustained argument on this matter from the opposition parties in spite of their protests on the costs of health insurance.
Ironically, the highlighted words on the attractive home page of the Health Insurance Authority are “Go Compare”. It is high time that the Minister or the authority took this advice and compared fees and charges with comparable EU states. This is not a complicated matter. In all jurisdictions either the insurers or the state will have fixed maximums which they consider justified for fees and charges on the whole range of procedures (exactly as is done here). – Yours, etc,
JOHN F JORDAN,
Flower Grove,
Killiney,
Co Dublin.