Focus of presentation Competition has a positive and important role to play in a system of universal healthcare. We don’t know the details of the Government’s proposals yet, so anything said is subject to revision… Useful however to consider some of the GENERAL lessons on getting the best from competition, based on our experience of other industries. Take-home message is that competition can be harnessed to achieve better outcomes in healthcare. “ better” here is not just focussed on cost/prices, but on overall value – ie. getting the best quality healthcare in the most cost-effective manner.
“ Exchequer funding for hospital care will go into a Hospital Insurance Fund which will subsidise or pay insurance premia for those who qualify for subsidy” “ The Hospital Insurance Fund will oversee a strong and reformed system of community rating and risk equalisation; provide direct payments to hospitals for services that are not covered by insurance such as A&E”
Isolde Goggin, Chairperson, The Competition Authority
UNIVERSAL HEALTHCARE: Getting the Best from Competition Isolde Goggin Presentation to National Primary Care Conference, Mallow 14 November 2012
Universal Healthcare: The Vision UNIVERSAL PRIMARY CARE Free GP Care for All UNIVERSAL HEALTH INSURANCE Compulsory Guaranteed UHI Package for all Free/subsidised for lower-income groups Competing public/private insurers
Creating the Framework Risk Equalisation System: Bill PublishedCrucial details still to come: Report of UHI Implementation Group White Paper on Financing UHI Devil will be in the detail!
Competition within a system based on Social Solidarity “Regulated Competition” Understand/Define the “Competition Space” Establish conditions for effective competition Get the incentives right!
“Three of us in this Marriage…” HOSPITALS & PRIMARY CARE PATIENTS Who treats the patient? Seek medical care or not? Admit/Treat the Patient? Who/Where to attend? Intensity/Frequency of Treatment? Which insurer to use? INSURERS Which provider to use? How much to pay for hospital services? Which “additional” services to cover?
Competition in Primary Care: How it looks Today Restrictions on competition removed - Opening-up of GMS Contracts - Advertising restrictions relaxed - Recognition of Training/Qualifications Patients benefit - Increased Innovation - More Choice - More Price Transparency
How might competition operate? PRIMARY CARE “Free GP care for all” No price competition at point of delivery Competition on Quality - Patients able to OBSERVE and RESPOND to differences - GPs must have an INCENTIVE to compete on quality Compulsory Patient Registration - Ensure SWITCHING is easy How will GP practices be funded?
How might competition operate? Hospitals COMPETITION FOR FUNDING • “Hospitals will be paid according to the care they deliver” • “Money follows the patient” - Static or Dynamic? Good INFORMATION and appropriate INCENTIVES critical for success SPECIALISATION vs. COMPETITION Striking the right balance
How might competition operate? Health Insurers “Same package of services to all”Basis for competition? Focus on Claims Inflation/Administrative efficiencies rather than Risk Profile Management? Supplementary Insurance/ “Top-Ups”? Scope for Selective Contracting? Price Negotiation/Bargaining Strength?IMPACT OF VHI MARKET POSITION??
Conditions for Effective Competition SUPPLY DEMANDRegulatory Regime “Enough” Information(Risk Equalisation; MarketRegulation) Ability to evaluate“Enough” Insurers and Quality of CareProviders Appropriate IncentivesFunding/Financial Ability to respondIncentivesAbility to respond