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Column Our fragile health insurance market faces collapse if age groups aren’t balanced
Clearly insurers are not building a mixed age profile of customers under their own steam, writes Patricia Conboy, who says those that don’t should be penalised.
THE COST OF private health insurance premiums in Ireland doubled between 2007 and 2012. Subscribers, young and old, are being priced out of the market.
The key to breaking this vicious cycle of rising costs and declining numbers of subscribers is the more equal division of older subscribers among the private insurance companies operating in the Irish market.
This entails radical legislative action from the Minister for Health. Legislation compelling each of the companies to insure a balanced proportion of older people and penalising those companies which fail to do so would be a game-changer.
Collapse
In the absence of radical action, Ireland’s fragile community-rated private health insurance market faces collapse. Community-rating means that everyone is charged the same rate for the same product regardless of their age, sex or health status. Effectively the risks of illness and the associated costs are pooled rather than individualised.
Older people tend to have higher rates of illness and to make more claims on their insurance for medical treatment. According to the Health Insurance Authority, the average 80 year old costs 11 times more than the average 0 – 49 year old.
Young people are typically healthier, ‘cheaper’ and more profitable for health insurers. The collapse of community-rating would mean that many people who are old, or sick, or both would not be able to afford private health insurance when they need it most.
Balance
Health insurance was opened to competition 17 years ago. Though companies are required to operate an open enrolment policy, there is little evidence that new companies in the market have actively targeted older people who are less attractive commercially for business. Currently, the distribution of customers aged 70 – 79 years is as follows : Aviva, 9 per cent; GloHealth, 0 per cent; Laya, 12 per cent; and VHI, 78 per cent. Clearly insurers are not building a mixed age profile of customers under their own steam.
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The impetus will have to come from legislation and, critically, from financial penalties for those who fail to incorporate a balanced proportion of older people in their market share. If community rating is to work in a market with multiple providers, it must be supported by an effective system of risk equalisation.
Essentially, this is a mechanism for managing and distributing health insurers’ differences in costs due to the differing ages and health status of their subscribers. Stamp duties are levied on health insurers to fund credits for older and less healthy customers. There are shortcomings in the Irish system of risk equalisation.
Firstly, the measurement of health status – a proxy indicator based on bed nights in hospital – is not fit for purpose. Secondly risk equalization rates are insufficient to compensate insurers for the costs of older, more expensive subscribers.
Equalisation
Earlier this year, the VHI estimated that risk equalisation rates compensated them for 55 per cent of the costs of their older customer base. The Department of Health’s view was that the rates were 70 – 75 per cent effective. Whichever estimate one takes, the size of the gap between costs and compensation is substantial.
These shortcomings, combined with the disproportionate allocation of older subscribers across the market make a lethal combination.
In November, the Minister for Health announced modest increases in risk equalisation rates. Companies with a younger market share objected loudly to the increases stating that these charges would drive further premium increases.
Why so? In fact what risk equalisation does is move money around the system from the young and the healthy to the old and the sick. If insurers had a mixed profile of customers, the stamp duty paid out and credits collected would balance each other out.
In passing risk equalisation charges onto their subscribers, companies are failing to effectively operate a mechanism which is fundamental to the maintenance of a community-rated private health insurance market.
Community-rating – a principle based on solidarity between young and old, between the healthy and the sick – is a principle worth defending with all the tools available to policy-makers. A legal requirement that each company operating in the Irish health insurance market take a balanced share of older customers, or suffer penalties if it does not do so, is both fair and transparent. The Minister for Health should legislate.
Patricia Conboy is an Independent Specialist on Ageing and Older People’s Issues. She was Director of Older & Bolder (2008 – 2013), and previously Policy Analyst with National Council on Ageing and Older People 2003 – 2008. You can visit her website here.
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If they are no longer carrying out their duties as councillors and are still getting paid, its a public issue, otherwise it is an internal party issue.
SF is a private non Governmental organisation. It does not need to answer to anyone but its members for any aspect of its internal organisation or procedures. It is free to do anything it wants. Just like the Church of Rome, or Scientology, or Moonwalkers.
Oh lord the same auld same old attack Sinn Fein at all costs from the same two jaded longterm residents of the Journal…… they are expelled and suspended respectively from Sinn Fein they are still elected councillors so payments to them as councillors have nothing got to do with SF, no Sinn Fein official is paid by the public or any official of any party,
thomas i read your post on enda being the less forthcoming with information than it was 2009. and your post seem to defend endas actions on this, now a few hours later you are all for transparency. oh and i have gave you the name of a journalist you did not want to find on the other post. here it is again.
Gemma ODoherty fired from Irish Independent for questioning Garda Commissioner
on the contrary. I see no reason for Sinn Fein to say anything about this. Their internal affairs are entirely their business. There is no public interest here at all.
“Several councillors expelled from FG in the past year or two”….yet magically all references to this have been wiped from the internet.
Kevin likes to make stuff up.
But the public knew why…it was all over the media why…that’s the difference. ..shin fein is run with like a military outfit. No dissent among the ranks. For all their faults the other parties allow differing opinion..
Told ye there would be a split – very poor leadership qualities under a republican banner in Sinn Fein – they have Irish water over a barrel and still don’t get an injunction to suspend the water meters …. faux republicans – at the top !
The councillors are lucky to only be expelled / suspended, because in years gone by those who displeased the Republican Movement didn’t see it coming either, usually because it was with a bullet to the back of the head. That is unless they were ‘rapists’ in which case they were moved either abroad or across the border….
Hermes, I’m glad that you acknowledge the parallels between the hiding and relocation of rapists and paedophiles carried out by both the Catholic church and by Sinn Fein.
Shinnerbots on full alert to red thumb any comment deemed derisory
A party calling for transparency in every aspect of politics but won’t apply it to itself .. Shameful behaviour, they should be leading the way in this aspect of politics
A vote for SF is a vote for another party that refuses to be held to accountable for any anything it does or promises in the run up to the next general election
Je suis u sure u are not talking about yourselves there……and Mr Doctor it is up to the people to decide not you who is in power but perhaps democracy is not a concept you are too familar with
Ahh ha ha – SF lecturing people on accepting the democratic will of the people!!! Just what was with all the support for the few thousand terrorists who specifically decided to bomb and shoot and beat people into changing their mind after the “democratic will of the people” didn’t go their way?
Generally speaking, if SF are against it, then it is a good place to start.
As for the public’s right to know? If these people were elected under the SF banner, then the morons that voted for them are entitled to know if they can reasonable expect SF policies to be supported in the future. Coming clean as to why they were expelled would be a good start to meeting that entitlement.
All political parties stand under that charge – the home of ne’er do wells and intellectuals deficient who can’t think for themselves – or Sassanachs as Colmcille would put it ……
It looks very suspicious, both were looking to stand at the general election. Sandra McLellan has been one of Sinn Fein’s weakest performers and would have been fighting to get through the convention if both stood.
Most political parties don’t comment on internal investigations, usually to ensure confidentiality of all involved but the people on the other end aren’t usually so constrained.
This blog has been written by a observer of the situation of East Cork Sinn Fein.
This was given to me today after what happened to my husband, i thought i would share it with you.
The East Cork area has long been a stronghold for Sinn Fein, but despite this, the party was not expected to take a seat in the constituency in the 2011 general election. You could say the political conditions of the time, namely the demise of Fianna Fail, created the perfect storm for the Sinn Fein candidate. Nobody was more surprised at the unexpected result than Sandra McLellan herself, who hardly canvassed on the run up to what was her second attempt general election attempt, believing her chances of taking a seat to be so slim.
Propelled into the national political sphere, McLellan, like all first-time TDs, was out of her depth. She wasn’t the only one learning the ropes however, with Sinn Fein trebling its representatives on the government benches to fourteen since the 2007 general election. She was joined from Cork by long serving Sinn Fein City Councillor Jonathon O’Brien, who topped the poll after two previous unsuccessful Dail attempts in 2007 and 2002.
McLellan became the second female deputy in the Sinn Fein government party, joining the highly experienced Mary-Lou McDonald. Sinn Fein has long been vocal in its support for better gender balance in Irish political parties, recently calling for the current 30% quota to be increased to 50%. At present Sinn Fein’s female representation in the Dail is 16%, the same as Fine Gael, and two percent less than Labour, who have the highest proportional female representation. Sinn Fein will be hoping to improve their gender ratio in the next general election, with many strong female candidates already ratified to run around the country.
It is possibly due to the fact that Sinn Fein are so desperate for a strong female presence in politics, that McLellan’s obvious weaknesses have been tolerated and excused over the years. After the initial excitement of winning the Sinn Fein seat in East Cork, the party membership quickly discovered that little would change in the constituency. The newly elected TD failed to keep her promises of constituency clinics, seldom turned up at events and was regularly accused of ignoring issues forwarded to her by both party members and the general public.
The upshot of this dismal performance over her three years in government was the embarrassing loss of the only sitting Sinn Fein county councillor’s seat in the 2014 local elections, that of Councillor Michelle Hennessy in the TD’s home town of Youghal. Ms Hennessy is also McLellan’s sister-in-law, making the poor vote even more personal to the TD. This loss came amid a landslide local election victory for Sinn Fein in Cork County, where they increased their elected representatives from one to ten in County Hall. The result appeared to come as a shock to the TD, although not so much to the party membership, many of whom were long predicting the loss of the seat in Youghal.
Instead of sitting down and going back to the drawing board after the local elections, McLellan and her supporters went on an assault in East Cork. They initially blamed the division of the Local Election Area, claiming the Midleton based candidate, sitting town councillor Pat Buckley and subsequently elected county councillor, had encroached their agreed areas. When no evidence could be found to support this claim, they went on to blame a general lack of support from the party in the area.
However the TD may try to sugar coat it, the loss of her sister-in-law’s seat, in her own home town, was a major reflection of the level of dissatisfaction felt towards the TD. There was little to be taken from this defeat but that the cherished and long fought for Sinn Fein seat would not be held by the sitting TD come the next general election. A more established party might have taken this result as the cue to start internal party talks, both at a national and local level. Sinn Fein, however, seemed reluctant to draw the wrath of the TD and the result was largely ignored, much to the disbelief of the East Cork membership.
After spending many months trying to get the attention of the party’s leadership, the membership seemed to take matters into their own hands. Two prominent and successful County Councillors, Kieran McCarthy, from Cobh, and Melissa Mullane, from Mallow, declared their intention to run against the TD at convention. The party’s apparent attempts at preventing a convention was now in tatters, and when an article appeared in the Evening Echo confirming the two councillors’ intention to contest, panic quickly took hold.
Councillor Kieran McCarthy, who topped the poll in the recent local elections, had never been shy in expressing his hope of taking a Dail seat for Cobh. The introduction of an emergency change to the Sinn Fein party’s constitution, stating that a male candidate could not contest the seat of a sitting female candidate, seemed to rule out his chances on a one-to-one contest with McLellan. As the new ‘gender rule’ only applied to Deputies Mary Lou McDonald and Sandra McLellan, and given that McDonald being contested was highly improbable, the move was viewed by the party membership in East Cork as a ploy to prevent a fair convention and force the sitting TD through as the candidate.
The ‘conveniently’ timed change to the constitution may well have worked for McLellan were it not for Mallow Councillor, Melissa Mullane, deciding to put herself forward for convention. There was nothing to prevent Mullane from doing this and so, it now seemed impossible to stop a democratic convention from taking place in East Cork. In a further worrying development, most cumanns in the area were calling for a two candidate strategy for the general election. It was felt that the size of the constituency, along with the swing towards Sinn Fein, warranted the gamble.
If a two candidate strategy was indeed accepted by the party in the area, then the running of Mullane against the sitting TD would take care of the new ‘gender rule’, and what’s more, would open up the opportunity for Councillor Kieran McCarthy from Cobh, to also get on the ticket. The negative feelings of the membership towards the TD, meant that she was almost certain to lose the vote, should a convention take place. This meant on a one candidate strategy Mullane would most likely be the candidate, and if two candidates were going forward to contest seats, McCarthy would join her. Either way, the sitting TD would be ousted.
This would have been hugely embarrassing, not just for the TD herself, but for the party in general. The fact that McLellan would have remained a TD for a possible year or so until an election was called, would have made for a very awkward situation. This seemed to be the view taken by the party leadership. In an effort to quash the revolt against the TD, the East Cork area organisers came down hard against those viewed as being against McLellan.
What followed was a further loss of control by the leadership over the area as the membership openly revolted against these heavy-handed tactics, which were viewed as both undemocratic and divisive. Seeing the membership moving further away from her, McLellan called an emergency meeting in Youghal between her home town cumann and the Ireland South leadership. At that meeting McLellan made serious accusations against various Sinn Fein Cork County Councillors, as well as some of the party’s paid area organisers. The accusations were viewed so damning that the entire Sinn Fein structure in East Cork was immediately stood down.
An internal inquiry panel was subsequently set up to investigate the various complaints made by the TD in East Cork. It was bizarrely headed up by Jonathon O’Brien TD, McLellan’s comrade in the Dail. The complaints, it appears, mainly focused on the two councillors who had expressed an interest in contesting the TD’s seat at convention, Kieran McCarthy and Melissa Mullane. A happy coincidence? Or a desperate last ditch effort by the TD to hold onto her seat? Both councillors refute any accusations of wrong-doing and are continuing on with their constituency work while the inquiry continues to take place.
As things currently stand in East Cork, the structure is stood down, pending the findings of the various inquiries. The TD is regularly slinging mud in the same two directions, and it seems that nobody has the ability to reprimand her increasingly erratic behaviour. Communication between McLellan and most of the East Cork membership is all but non-existent, and it seems her recent behaviour has deemed a reconciliation unlikely. In fact, many members are now openly stating that they will not canvass for the sitting TD should she go forward as the candidate for the upcoming general election.
The party now stands at a crossroads in East Cork. If it does not take control of the area and listen to its membership, it is likely that the exodus of existing members will continue, new members will be deterred from getting involved and ultimately this traditional Sinn Fein stronghold will collapse. The party’s handling of issues in the area has shown both a lack of understanding and a loss of connection with its membership. Internal squabbling is certainly nothing new in politics, but shutting down an entire area’s structure is a foolish move. A cynic might be excused for thinking the party was willing to sacrifice the East Cork membership, for the sake of keeping the TD content. Perhaps in this case, the party has underestimated the resolve of its members.
Just shows that Mary Lou, Gerry and Pearse don’t know there geography beyond Kildare. What an embarrassment. Lord I never knew all that about Sandra…..wasn’t her father a councillor before her in Youghal…..
My sources locally would say Mis McLellan is completely out of her depth and was more shocked than anyone else to take the seat which was widely seen as a kick in the arse to FF in the area. The woman has not really progressed much beyond been ” Excited to be the youngest TD for the area up in Dublin “… Hard graft gets you elected the second time and I am not to sure how much she has done of that
Caoimhin… I don’t care what they are suspended from. If SF will not divulge ther reason for their expulsion/suspension then how can you or I evaluate the principles of the party?
They are not being fully open and transparent. It does not matter what the reason is, the fact is they are being secretive. End of.
End of no, i suspect given your incognito name and parody name you have well made up your mind already mo chara, you ashamed of your political views ? well i stand over mine in a transparent manner
Je Suis, you seem to know a lot about me in your own mind at least and seem to believe everything that is written in the media is fact, it is easy for you to make allegations from incognito land and not stand over them, yes I am a proud republican and will not apologise to the “invisible ” man for it. I am not a parent not that it is your business and i am publically a Sinn Fein activist and your attack on me as a person in regard to whether or not I have children is well quite low and pathetic really, again you know who i am and you hide throwing dirt, i think that says it all really
You are defending the indefensible Caoimhin. You can’t have it both ways as you as a party are always and rightly calling for transparency. This is hypocritical by Sinn Fein
It is an internal party matter, the people suspended and expelled have 21 days to appeal that sanction, political disputes and dis-agreements and parties having to sometimes take disciplinary action are part and parcel of political life (esp in this country). It amazes me the level of interest in this SF party matter,
I do not get it, well i do actually it is an attempt by the same jaded incognito accounts to attack SF and members of Sinn Fein for mostly their own political reasons
Only a matter of time before this gets out. Should just come out and say what these 2 have done and give their version of events before the media does it for them.
Ah it’s ok
A SF internal review has been held (well that’s a step up from a Kangaroo court I suppose)
Two members have been disciplined via suspension and removal from the party (better than a kneecapping I suppose)
And it’s no ones business but theirs
(That’s transparency for ya)
Says Angela Coll Fianna Fail activist and professional anti SF campaigner, What a laugh ” Galway tent Fianna Failed” talking about transparency…its not even first of April for 10 more months
Ah now Caoimhin I’m hardly a FF activist I’m not elected to anything never received a cent from anyone as a FF member either
We have moved on from the Galway tent you know
Remind me though how much did SF raise in the US fundraising in the last 12 months?
And if I were a professional at criticising SF you’d think I’d be getting paid for it
Where should I send the bill?
When an adult uses terms like fine fail and baby blues shirts and refers to media as Sindo you know your engaging with an easily led sheep , brainwashed by the cult of SF
You know right well Angela that monies raised abroad cannot be spent in Ireland on an election campaign, I would like to think FF have moved on from the Galway tent mentality but i see no evidence of it…it is interesting though that you seem to think party activists should be paid
Well Je Suis adults do not usually hide in incognito and in fairness to Angela she stands over her comments and does not hide from them, maybe you should consider doing the same
I never said FF activists should be paid Caoimhin
Perhaps you should read my comment again
I was referring to where you described me as a “professional anti SF campaigner”
If I’m professional at it does that mean I’m good at it (reels in shock at the thought of a back handed compliment)
And more importantly
FFS all this whining about transparency from the Blueshirts when all it takes is a quick Google search to figure out what is going on. If ye want the full in depth story I suggest ye read the next issue of Phoenix magazine in the mean time I wouldn’t be so worried about what happens in Cork East as I would be worried about when the Fennely report comes out. It’s gonna take all of the Party’s Loyalists (Southern Command) to rally around and protect their fearless leader Edna. A little spat over election selection in Cork East is going to be noting compared to the duck and cover when that report comes out.
you are right fg asking about transparency would be quite laughable on any issue god i thought ff were champions in ducking and diving but i willl have to admit the party that wins that prize would be fg.
The only comrade caught with cash from the Northern Bank robbery was a Cork man, any chance there’s a connection Brian or is that only wild speculation. I could be wrong but off the top of my head there’s still €25 million missing ? What’s the party rules on that ? if money was robbed in the north, could it be used in the South, visa verse ? or would it come under the 1 country 1 party rule ????
This blog that was originally published a few months ago probably tells the real story of why these two councillors were mysteriously kicked out of the party before the convention https://anrebelogblogs.wordpress.com/
This is very interesting and if true would definitely shed light on these events. However that particular post was published 2 hours ago and I can’t find the post that was published a few months ago.
Shock horror there are disputes in Irish politics within political parties, such major news for the ” baby blueshirts ” and the ” Fine Failed ” incognito bots to get excited about, these folks not so prominent in demanding transparency in regard to Golden circles and allegations of preferential treatment been given to backers of their parties
You have to wonder what terrible thing they did to get themselves expelled! Handle explosives? Cover up sexual abuse? Order the death of a mother of young children? Must have been far worse than that I imagine!
Rather poor atempt by the Journal to lure the bitter loyalist in another 36 hour non stop rant in an effort to raise post count.Christ the rant about prince Charles and Shergar meeting Our Jarry was very entertaining in all fairness.He has at least 5 posts up already but I can’t see the hoofs hitting the keyboard for another 34 hour’s, then again maybe not.
SF, like any other political party, are concerned with winning votes and that means putting the best possible slant on everything that happens within SF, including avoiding anything that could damage getting votes. Whether SF will be relatively better or worse than FG, FF or Labour in this regard will only be know if / when SF get ‘into power’. Just rotating parties every general election won’t address that fact that our political system is ‘broken’. If anyone doubts SF are in the same ‘game’ as the other parties, then I’d advise you to pay attention: there’s been enough evidence of it over the last year alone (especially the changing positions on Irish Water as it became clear how much public opposition there was and how many votes were in play). Again, I’m not saying SF are doing anything that FG, FF and Labour haven’t been doing for decades.
I find it strange that Sinn Fein would risk losing a seat in Cork East rather than give an opportunity to a new candidate (s) when Sandra McLellans’ performance is widely criticised most notably amongst SF’s own party members in her constituency. The notion that it would undermine her position as an elected representative during the remaining tenure of the current government is laughable, she is a largely unheard of TD in opposition….what is there to undermine?
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Ensure security, prevent and detect fraud, and fix errors 92 partners can use this special purpose
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Your data can be used to monitor for and prevent unusual and possibly fraudulent activity (for example, regarding advertising, ad clicks by bots), and ensure systems and processes work properly and securely. It can also be used to correct any problems you, the publisher or the advertiser may encounter in the delivery of content and ads and in your interaction with them.
Deliver and present advertising and content 99 partners can use this special purpose
Always Active
Certain information (like an IP address or device capabilities) is used to ensure the technical compatibility of the content or advertising, and to facilitate the transmission of the content or ad to your device.
Match and combine data from other data sources 72 partners can use this feature
Always Active
Information about your activity on this service may be matched and combined with other information relating to you and originating from various sources (for instance your activity on a separate online service, your use of a loyalty card in-store, or your answers to a survey), in support of the purposes explained in this notice.
Link different devices 53 partners can use this feature
Always Active
In support of the purposes explained in this notice, your device might be considered as likely linked to other devices that belong to you or your household (for instance because you are logged in to the same service on both your phone and your computer, or because you may use the same Internet connection on both devices).
Identify devices based on information transmitted automatically 88 partners can use this feature
Always Active
Your device might be distinguished from other devices based on information it automatically sends when accessing the Internet (for instance, the IP address of your Internet connection or the type of browser you are using) in support of the purposes exposed in this notice.
Save and communicate privacy choices 69 partners can use this special purpose
Always Active
The choices you make regarding the purposes and entities listed in this notice are saved and made available to those entities in the form of digital signals (such as a string of characters). This is necessary in order to enable both this service and those entities to respect such choices.
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