Thursday, March 04, 2010

Doctor, doctor! How's business?

Could always be better.

I don't find the Dr., dr., jokes very funny either, but their traditional popularity is difficult to contend with..

Here's the latest one :
What does this policy achieve?
(besides insulting everyone with the slightest intelligence)

The poorest 35% of the population already visit the GP for free in Ireland. The remaining 65% are able to claim tax relief on all their GP expenses.

What is behind this idea? I'm not aware of any evidence to suggest that it might improve health. In fact there is much more evidence to suggest that it will exacerbate problems in health care; for one, it amounts to "over-insurance" which is one of the main drivers of excessive medical inflation. I do expect there to be something more to this plan than the slogan, but at any rate, it seems like more of the unfortunate "here you go, vote for me"style of politics that we know served us poorly in the past. By applying the strategy to healthcare they are totally undermining their political credibility. Why don't they just be honest about it and hand out fifties - it would be cheaper and wouldn't lengthen queues and shorten examination times at the GP's clinic.

One obvious place to start is with the recommendations of the recent Competition Authority Report about GP practices.

10 comments:

Liam Delaney said...

Peter - i can't tell from the poster what is being proposed. Can you enlighten us?

Enda Hargaden said...

Universal health insurance, I think - http://www.faircare.ie/qa.html#what

Mark McG said...

The poster in isolation doesn't look great I agree, but in fact it's only the final phase in Fine Gael's proposal for implementing a system of universal health insurance. It at least seems to be in line with some of the more successful European models.

See www.faircare.ie for more details.

I’ll refrain from making any political statements, but people shouldn’t forget the circumstances which surrounded the extension of medical card coverage in 2002.

Out of interest Peter, where did you get your figure of 35%?

Peter Carney said...

Liam,

Ok. It's not actually as simple as it might at first seem, in fact this poster is rather misleading.

The proposal is: Free GP visits for everyone... who has mandatory private health insurance.

"Free for you" in this case actually means that government policy will make it MANDATORY that you take out insurance against the first euro of potential costs associated with health care. It is well known that "fist euro" insurance is highly inefficient -- it is referred to as over-insurance (excess cover that logically implies a risk aversity beyond sense) and is well known to result in moral hazard, and excessive medical inflation, which as well as being completely inefficient can actually cripple a heatlh care system. Furthermore, if such a policy wasn't coupled with an increase in the number of practicing GPs (no mention of this at all) it will also lead to an increase in waiting times and a general decline in the quality of primary care service.

If access to GP services is a real problem then we might consider increasing the number of GPs in Ireland as a way of fixing it. The CA have also suggested that GP numbers should be increased.

Note that: according to the OECD, we currently have 1 GP per 2,000 people in Ireland. The UK has about 40% more, Canada and US have twice as many (1 per 1,000), France and Germany have three times as many (1 per 650). To mean this seems like an obvious place to start.


There is more details of the FG plan on http://www.faircare.ie/

Liam Delaney said...

"and is well known to result in moral hazard, and excessive medical inflation, which as well as being completely inefficient can actually cripple a heatlh care system."

These don't have to be Journal of Economic Survey articles Pete, but at least a passing reference to a key paper that shows this would be good.

Martin Ryan said...

Are there any more details available about the tax relief for GP expenses? I wasn't aware of this myself, and I wonder how many other people are?

Of the "remaining 65%", do we have any sense of how many don't visit their GP - because they view it to be too expensive? Surely this is not zero?

And finally, how would one go about answering the question: Are GP visits in Ireland expensive? Of course, everything is relative, but we could take the average industrial wage as a starting-point. We could debate back and forwards which figure to use, but let's take the CSO average industrial earnings per week for 2006. This figure is €575 per week.

It's been a while since I last visited the GP, but I understand that people pay somewhere between €50-60: approximately one tenth of the average weekly wage. This seems expensive enough to me. Finally, what about those earning below the average weekly wage? At what income level does one become ineligible for the medical card?

Peter Carney said...

Mark M.

35% was a conservative estimate based on about 32% of the population having a full medical card and 3% having a GP card.


The raw figures are 1,478,560 full cards and 98,325 GP cards which totals 1,576,885 (end of 2009). Latest population estimate is 4,459,547 (end of 2008) so the per cent with cover is 35.36

Peter Carney said...

Sorry, for the most part, all this was shown in the RAND experiments; generosity of cover (10% to 100%) directly related to service use but NO result for actual health.

AER:
http://www.jstor.org/stable/1804094

JHE:
http://tinyurl.com/yb69cxm

Peter Carney said...

Martin,

1)Information on tax relief is available from http://www.citizensinformation.ie/

This tax relief was advertised fairly widely last year cause people weren't claiming it. I recall some posters on Dublin Bus.

2) You would be able to estimate the numbers of non-medical card holders *(the 65%) who do not visit GP's for financial reasons from the SLAN data. I would also guess that its not zero.

On this, its worth flagging an article in the IT by Paul Cullen last Tuesday:

http://www.irishtimes.com/newspaper/health/2010/0302/1224265424200.html

3) The average cost per visit is €50 (-20% tax relief).

The Competition Authority have suggested that one of the factors keeping prices high is the shortage of GPs; relative to international levels. If one looks at medical inflation; it's fair to conclude that it's not getting any cheaper.

4) Eligibility for medical card depends not only on income, but age (seniors), family composition and size, and in some cases undue hardship resulting from illness or disability.

Generally, people on Welfare benefits are entitled but once one starts to earn income they are no longer entitled. Weekly, it's €185 for a single person and €265 for married couple + an extra €40 for each child.

Martin Ryan said...

Cheers for all the info Peter; and the extra comments!