Somebody has to pay the cost of health care

ON GAELIC GAMES:There is a culture within the GAA that resents bearing the cost of things and expects others, generally at higher administrative levels, will sort it out, writes SEAN MORAN

ON THE face of it, the news that the GAA is to cut physiotherapy cover for players on financial grounds was untimely. The merger with the Gaelic Players Association is just bedding in pending approval at next month’s annual congress, and a development of this nature plays to the stereotype of clerical parsimony winning out over player welfare, an image reinforced by the evident disproval of Croke Park’s heavyweight medical, scientific and welfare committee.

As ever with GAA matters, the reality is more complex.

But first, a digression: some years ago a candidate (ultimately successful) for the GAA presidency pointed at the car park of the hotel in which he was being interviewed and said that on Saturday mornings the local rugby club would pick up its players and that they all would hand over their bus fare without hesitation.

Were that to happen in the GAA, he said wistfully, you’d be chasing fivers and tenners for months. There is a culture within the organisation that seems to resent bearing the cost of things and to expect others, generally at higher administrative levels, will sort it out.

The old players’ injury scheme, discontinued in 2003, was intended to complement the standard injuries scheme, designed for major medical interventions and to cover the cost of day-to-day expenses such as physiotherapy.

It was a voluntary scheme costing £20, and later €25, but despite its virtues being regularly trumpeted at congresses and on other platforms, the numbers willing to pay a small amount to insure themselves remained pitifully inadequate. A scheme needing 250,000 subscriptions never exceeded 14,000 and was eventually withdrawn.

At the 2004 congress, then-director general Liam Mulvihill observed when discussing the withdrawal from the scheme by the underwriters: “We then had the option of leaving the players who had supported the top-up scheme with lesser benefits in the coming year or of extending the range of benefits in our scheme to replace the abandoned scheme. We chose the latter course out of concern for our players, and inevitably there is a cost involved, so the cost to clubs is increased substantially.

“This is going to be a burden for clubs and one which will put the weaker ones under substantial pressure. Perhaps it will be the catalyst for forcing the clubs to charge a realistic membership fee and collect it from all their members.”

So, as a result, physiotherapy and everyday costs refundable under the players’ injury scheme were taken into the general scheme, funded by registration fees payable by club teams throughout the association.

Currently, that scheme covers a great deal, from medical attention to compensation for lost wages. Though there have been complaints at the time reimbursement takes in some cases, the scheme does represent exceptional value compared to the commercial costs and similar schemes in other sports.

Faced with the need to reduce the costs of the scheme, which has become in recent years effectively insolvent – to the tune of €3.5 million within three years – and requiring Central Council bail-outs, the insurance work group formulated a series of proposals designed to save the €1 million needed to balance the books for this year.

The cutting of physiotherapy costs was reached after floating other proposals, such as cutting back on lost wages’ compensation, reducing the limits on medical cover or introducing a loading on premiums.

This would be aimed at counties which consistently claim more than their total premiums. One big GAA county’s claims, for instance, have four times in the past five years outstripped its paid premiums – and it wouldn’t even be in the top dozen of claimants.

Having toured their presentation to various club fora, the work group took the decision to remove physiotherapy.

Access to physiotherapists has increased at an exponential rate – a scheme intended to cater for essentially medical treatment expanded to include frequently un-monitored and un-referred visits, with bills being sent to the club for forwarding to Croke Park.

For the GAA’s medical committee the initiative has been unwelcome and some members of the committee wanted to resign over the restriction.

Physiotherapy is seen as an important part of the control and management of injuries.

As was pointed out by the Irish Society of Chartered Physiotherapists last week: “Early physiotherapy intervention in the diagnosis, treatment and management of injuries is a cost-saving, as physiotherapy aids players make a prompt recovery and facilitates not only the return to sports activity, but also a speedy return to everyday tasks including work.”

This is accepted by the insurance work group, but, as one member put it: “This is a simple question of money in and money out.”

Were team registration fees to rise from €1,000 to €1,500 there would be no problem in meeting the costs, but clubs, already beset by the recession and plummeting revenues, would be outraged by a 50 per cent hike in this cost. Yet, that would mean a per capita increase of €20, assuming 25 players in a team group, from €40 to €60. One industry source says that commercial cover would be available at between €350 and €400 per annum – between six and seven times the in-house cost.

The problem is that the scheme, although it represents very good value, still costs clubs, which, as Mulvihill pointed out six years ago, often have to chase members for subscriptions.

In fact, while on the road, the insurance work group heard some club representatives calling for the scheme to be scrapped altogether because of the cost.

This is unlikely to be the end of the matter.

Dr Danny Mulvihill (no relation), chair of the medical committee, is due to meet president Christy Cooney soon to press for a more root-and-branch reform of medical costs rather than the simple targeting of one important branch of sports injury science.

That is a sensible approach and one to which no one could object. But no matter what the scale of any eventual scheme, there is one pressing reality: at the end of the day, someone has to pick up the tab.