Source document: https://docs-lawep.s3.us-east-2.amazonaws.com/1697804683997.pdf (Ireland)
Insurance Ireland Submission to the Oireachtas Committee on Covid-19 Overview of health system capacity for non-Covid-19 healthcare.

July 2020 Insurance Ireland welcomes the opportunity to make this submission on behalf of the three Private Health Insurers operating in the Private Health Insurance market.

Insurance Ireland is the voice of Insurance in Ireland and represents the Irish private health insurance, general insurance, life assurance, reinsurance, and captive management sectors.
Insurance Ireland represents 140 companies providing insurance domestically in Ireland and internationally from Ireland.

Total industry employment is approximately 28,000 people both directly and indirectly with one in four jobs in financial services being in insurance.

Our members pay out more than €13 billion in claims and benefits to Irish customers annually and contribute over €1.6 billion in tax to the Irish exchequer each year.
The Private Health Insurance sector pays over €2 billion annually for healthcare treatment for its customers and this represents a considerable contribution to the overall spend on healthcare in the country.
Throughout this public health crisis the Private Health Insurers have relieved the burden on the public health system with the provision of ancillary healthcare benefits and services offering direct access via telemedicine to clinical experts online including GPs, Clinical Psychologists, Physiotherapists, Dieticians, Practice Nurses, Physical Therapists, Occupational Therapists, Speech & Language Therapists and Employee Assistance Programme consultations.
Private Health Insurers have endeavoured to provide acute healthcare supports for non-Covid related illnesses, diverting them from acute hospital settings and thereby relieving the burden on the public health system.

The impact of the Covid-19 pandemic since Ireland recorded its first case of Covid-19 on 29th February resulted in unprecedented pressures being placed on our healthcare system.
The emergency measures implemented – including the temporary control of the private hospital network were necessary to ensure there was extra hospital capacity available to respond to any Covid-19 related demand – thankfully any anticipated surge in Covid related cases was reduced due to the lockdown measures undertaken and the adherence and compliance with the public health advice recommended by NPHET.
Private Health Insurers were happy to play their part in supporting the collective national efforts to tackle Covid-19.

Covid-19 has had significant impacts on health insurance customers where many experienced reduced access to private services either due to the postponement of non- urgent hospital care or the lack of access to private hospitals over the duration of the HSE’s agreement with the Private Hospitals.
The Private Health Insurers have each taken prompt actions to support customers including specific customer supports for those who faced financial difficulties and the provision for all members with premium waivers and rebates along with benefit payments of more than €300 million.
SCC19R-R-0465 D One of the knock-on effects of having to deal with the immediate and sudden priority of Covid-19 was the postponement of all non-essential surgery, health procedures and other non-essential health services across the healthcare system, resulting in delays for scheduled healthcare procedures in both community and acute settings.
The reopening of these services will pose a significant challenge to the entire health system as the pause in non- urgent care has exacerbated the backlog of people on waiting lists, with almost 576,000 people on the outpatient waiting list up to the end of May.1, and a 12% increase on the inpatient waiting list from the end of March to the end of May 2 and in total over 800,000 on some form of NTPF waiting list.
It is welcome that the HSE has published its strategic framework for delivery of service continuity in a Covid environment in June, as this allows all stakeholders to understand the broad range of issues to be examined as services increase for non-Covid related care.
Some levels of capacity are becoming available to begin services again and the priority of Private Health Insurers is to ensure the 2.2 million people with private health insurance, representing 46% of the population in Ireland, have access to timely healthcare, including screening services and that capacity is utilised as effectively as possible across the whole healthcare system to treat as many people as possible, while recognising the need to protect some capacity for any Covid related surge.
Insurance Ireland would welcome clarity as to the role of private hospitals in clearing existing waiting lists and how the National Treatment Purchase Fund will be used in this regard.

It is widely acknowledged by all stakeholders that there are deficits in public hospital capacity including acute bed numbers, critical care, infrastructure, and recruitment – especially regarding consultant vacancies.
The acute public hospital system has an average bed occupancy of almost 95%3 - among the highest in OECD countries.

This can go beyond 100% during the winter season leading to delays in treatment and overcrowding in Emergency Departments – something that could be exacerbated by any surge in Covid cases during the next winter flu period as Hospitals adopt new ways of delivering care to accommodate the infection prevention strategies required to mitigate the risk associated with Covid.
Insurance Ireland suggests that in order to prepare for the winter flu season and the possibility of a surge in Covid-19 related cases that it is timely to review the recommendations of the 2018 Health service capacity review and the National Development Plan 2018-2027, which proposes opening 2,600 public hospital beds in the period.

There is merit in the circumstances to expedite a full review of these recommendations.
Implementation of Sláintecare Private Health Insurers support the objectives of Sláintecare, which are based on considerations of fairness and equality of access.
Points in the Sláintecare strategy made in relation to better health outcomes arising from its implementation are conditional on additional investment in capacity and services beyond existing levels to address the widely acknowledged shortages in the public healthcare system including hospital bed capacity, critical care, and investment in additional infrastructure in acute and primary care.
1 https://www.ntpf.ie/home/pdf//2020/05/nationalnumbers/out-patient/National03.pdf 2 https://www.ntpf.ie/home/pdf//2020/05/nationalnumbers/in-patient/National01.pdf 3 https://www.oecd-ilibrary.org/docserver/2393fd0a- en.pdf?expires=1593602289&id=id&accname=guest&checksum=3570C3B2265F385076882CCED56DAD69 SCC19R-R-0465 D The Sláintecare policy envisages a healthcare system in which appropriate healthcare services are shifted from acute to community settings in as many areas as possible, alleviating acute capacity constraints and the Private Health Insurers are supportive of this.
Delivering appropriate healthcare solutions in the most appropriate healthcare settings is a key component of any sustainable healthcare system, and this should be a critical consideration in the scope of analysis of the provision of healthcare into the future.

All patients in public hospitals pay their taxes to access the healthcare service until they waive their right to be treated as a public patient and utilise their health insurance.
Any assertions about freeing up significant capacity by removing private care from public hospitals are unclear and have been examined by the Independent Review Group, chaired by Mr Donal De Buitleir, which was established to examine the removal of private activity from public hospitals.
This Independent Review Group concluded that removing private activity from public hospitals is not a “magic bullet” and is unlikely to generate significant additional capacity in the short term as much of the activity will remain in public hospitals and will simply become public activity.

This is because 80% of all admissions to public hospitals are emergency admissions, typically through the A&E, which will not change even if private activity is removed from public hospitals.
Insurance Ireland believe the decision to separate public and private should only be considered after all the enabling investments are made to meet the healthcare needs of an ageing population, such as investment primary care facilities and integration of primary and community care; consultant recruitment and contracts finalised, and increased acute hospital capacity.

The recently appointed Minister for Heath has stated he would like to accelerate the implementation of Sláintecare.
To achieve this Government needs to proactively engage with the Private Health Insurance Companies, who already purchase €2bn of healthcare services on behalf of their customers and continue to relieve the pressure on capacity within the public healthcare system.
Any planning done in isolation raises the possibility of adverse or unintended consequences and the current mix of public and private care cannot be disentangled without prudent implementation timelines and considerable investment in infrastructure – as it would compound the public capacity issues acknowledged by all stakeholders.
We acknowledge the considerable work of the Committee in monitoring the State’s response to the Covid-19 pandemic and the important role it plays as the country navigates its way through the re-opening of non-covid healthcare and dealing with the current treatment backlog.

ENDS.

SCC19R-R-0465 D