10/8/13

Alternave Models Catherine Whelan

Chief Execuve, Independent Hospitals Associaon of Ireland

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Agenda IHAI Introducon

Challenges

The Future

Universal Health Insurance

IHAI Introducon Who We Are Representave group for the independent hospital sector in Ireland

Our members operate almost one-third of Ireland’s acute hospitals

Represent 21 independent hospitals providing acute & mental health services

We believe that a high performance health system should provide paents with easy access to quality services at an affordable price

IHAI aims to help its members to deliver this vision to the paents they serve

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IHAI Introducon Our Contribuon to Paent Care Naonally c1,000,000 bed nights provided per annum

1 in every 6 available hospital beds

400,000 paents cared for per annum (1 in every 5)

250,000 theatre procedures completed each year

3,000,000 diagnosc tests undertaken per annum

c22% of all mental health care treatment

c50% of all open heart surgeries

c65% of all spinal surgery

8,400+ people directly employed across Ireland

IHAI Introducon Our Members

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IHAI Introducon: Treang 400,000 Paents Naonally p.a.

Bon Secours Hospital Blackrock Clinic St. Joseph’s Hospital, Sligo Hermitage Clinic Highfield Healthcare Mater Private Hospital Dublin Mount Carmel Hospital Sports Surgery Clinic Bon Secours Hospital, Galway St John of God Hospital Galway Clinic St Patrick’s University Hospital

Barringtons Hospital, Limerick St Vincent’s Private Hospital UPMC Beacon Hospital Clane Hospital, Co. Kildare Bon Secours Hospital, Tralee

Aut Even Hospital, Kilkenny

Bon Secours Hospital, Cork Whiield Clinic, Waterford Mater Private Hospital Cork

IHAI Introducon: Membership Criteria To qualify for IHAI membership, a hospital: . Must be in the independent (non-State) sector . Must provide acute medical, surgical or psychiatric inpaent services . Must be accredited by an internaonally recognised accreditaon body1

If a hospital ceases to meet the criteria, its membership ceases

1 For example, Joint Commission Internaonal, CHKS Health Accreditaon, Mental Health Commission, etc.

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IHAI Introducon: Innovaon Key role in introducing leading edge technology/ experse: . PET CT, Cardiac CT, MRI . Transcatheter aorc valve implantaon (TAVI) . Linear Accelerators . Stereotacc radiosurgery: Cyberknife . Renal artery denervaon . Mul-speciality roboc assisted surgical programme . Minimally invasive mitral valve repair . Prostate radioacve seed implantaon

Challenges: Independent Hospitals Unstable private health insurance market

Underulised capacity

Reduced procedure prices paid by private health insurers

No role in naonal healthcare reform

Medical manpower challenge

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Challenges: Naonal Healthcare System Many common challenges across the system . Budgetary . Capacity and resources . Innovaon and efficiency

Current “Two Tier” system serves no one well, parcularly paents . No integrated approach to resource/capacity planning . Underulised independent sector capacity, overburdened public sector . Lack of opportunity to share best pracce, efficiency, innovaon . Balance of collaboraon and compeon is possible and would be posive for paents

The Future: Universal Health Insurance

Central plank of Government’s health policy

Due for implementaon from 2016

“Single Tier” health system - access based on need, not ability to pay

IHAI supports the introducon of a Universal Health System that provides paents with access to a high quality, affordable service

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Universal Health Insurance: Our Understanding

Every cizen insured for a “standard basket” of health services

No opon for insurers/providers to sell faster access to services

No disncon between insured and uninsured paents

Universal care through independent Not for Profit Trusts & Private Hospitals

Mul payer model, compeng insurers

Universal Health Insurance: Crical Path

Ambious metable for implementaon 2016 Significant deliverables/interdependencies, including: . UHI White Paper 2013

. Paent Safety Agency 2013 (administrave basis)

. VHI Authorisaon 2013 (end)

. E-Claims Implementaon 2013 (pilot)

. Money Follows the Paent 2013 (shadow) . Hospital Trusts ?

. Licencing 2015 (start)

. Universal Primary Care 2015 (full) . Underlying legislaon (Licencing Bill, etc.)

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Universal Health Insurance: Our View

Fully supporve of the principle

No engagement of the Independent Hospital Sector to date . Movement to single er health system without involvement of one of the current ers . Significant experience: cosng/pricing . Potenal linkages to Hospital Groups/Trusts . No inclusion in UHI Implementaon Group or Health Insurance Forum

Transional arrangements . Potenal instability & dri in short-medium term

Universal Health Insurance: Uncertaines/Risks Introducing structural change in a contracng fiscal environment, significant upfront cost Very ambious metable & significant interdependencies/deliverables Will it achieve the promised cost control (Dutch System 12% of GDP) Unstable Private Healthcare Insurance market in medium term Sustainability of Independent sector in the interim Perspecves of all stakeholders need to be considered in the overall design Need to ensure open and fair compeon between all providers Pricing mechanism must reflect full economic cost (e.g., capital, pensions, etc.)

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Universal Health Insurance: Opportunies, The Posives Greater equity of access for paents Broader Market/Single System More equal compeve playing field Beer integraon (Capital Programmes, Service Strategies) Promote high standards and efficiencies Simplifies complex range of insurance plans

Universal Health Insurance: Summary Supporve of all reforms that improve the quality of healthcare provision Agree with UHI principle - care provided on basis of need, not ability to pay Opportunity to consider early implementaon in certain areas Concerned that no engagement of independent sector in design/ planning to date Transional arrangements have potenal to destabilise in short- medium term Want to bring our resources and experse to bear to deliver healthcare reform

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Alternave Models Catherine Whelan

Chief Execuve, Independent Hospitals Associaon of Ireland

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