Universal Healthcare: Getting the Best from Competition

1. UNIVERSAL HEALTHCARE:
Getting the Best from
Competition
Isolde Goggin
Presentation to
National Primary Care Conference,
Mallow
14 November 2012

2. 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

3. Creating the Framework
 Risk Equalisation System: Bill Published
Crucial details still to come:
 Report of UHI Implementation Group
 White Paper on Financing UHI
Devil will be in the detail!

4. Competition within a system
based on Social Solidarity
 “Regulated Competition”
 Understand/Define the “Competition
Space”
 Establish conditions for effective
competition
 Get the incentives right!

5. “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?

6. 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

7. 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?

8. 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

9. 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??

10. Conditions for Effective Competition
SUPPLY DEMAND
Regulatory Regime “Enough” Information
(Risk Equalisation; Market
Regulation) Ability to evaluate
“Enough” Insurers and Quality of Care
Providers Appropriate Incentives
Funding/Financial Ability to respond
Incentives
Ability to respond

11. From this…..

12. To This!

13. For further information:
-Website: www.tca.ie
-LoCall: 1890 220 224
-Follow us on Twitter @CompetitionIrl