10/8/13 Alternave Models Catherine Whelan Chief Execu.ve, Independent Hospitals Associaon of Ireland 1 10/8/13 Agenda ! " IHAI Introduc.on ! " Challenges ! " The Future ! " Universal Health Insurance IHAI Introduc.on 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 2 10/8/13 IHAI Introduc.on Our Contribu.on 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 diagnos.c 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 Introduc.on Our Members 3 10/8/13 IHAI Introduc.on: 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 Whiaield Clinic, Waterford Mater Private Hospital Cork IHAI Introduc.on: 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 Interna4onal, CHKS Health Accredita4on, Mental Health Commission, etc. 4 10/8/13 IHAI Introduc.on: Innovaon ! " Key role in introducing leading edge technology/ exper.se: ." PET CT, Cardiac CT, MRI ." Transcatheter aor.c valve implantaon (TAVI) ." Linear Accelerators ." Stereotac.c radiosurgery: Cyberknife ." Renal artery denervaon ." Mul.-speciality robo.c assisted surgical programme ." Minimally invasive mitral valve repair ." Prostate radioac.ve seed implantaon Challenges: Independent Hospitals ! " Unstable private health insurance market ! " Underu.lised capacity ! " Reduced procedure prices paid by private health insurers ! " No role in naonal healthcare reform ! " Medical manpower challenge 5 10/8/13 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, par.cularly paents ." No integrated approach to resource/capacity planning ." Underu.lised independent sector capacity, overburdened public sector ." Lack of opportunity to share best prac.ce, efficiency, innovaon ." Balance of collaboraon and compe..on is possible and would be posi.ve 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 introduc.on of a Universal Health System that provides paents with access to a high quality, affordable service 6 10/8/13 Universal Health Insurance: Our Understanding ! " Every ci.zen insured for a “standard basket” of health services ! " No op.on for insurers/providers to sell faster access to services ! " No dis.nc.on between insured and uninsured paents ! " Universal care through independent Not for Profit Trusts & Private Hospitals ! " Mul. payer model, compe.ng insurers Universal Health Insurance: Cri.cal Path ! " Ambi.ous .metable for implementaon 2016 ! " Significant deliverables/interdependencies, including: ." UHI White Paper 2013 ." Paent Safety Agency 2013 (administra4ve 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.) 7 10/8/13 Universal Health Insurance: Our View ! " Fully suppor.ve 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: cos.ng/pricing ." Poten.al linkages to Hospital Groups/Trusts ." No inclusion in UHI Implementaon Group or Health Insurance Forum ! " Transi.onal arrangements ." Poten.al instability & drik in short-medium term Universal Health Insurance: Uncertain.es/Risks ! " Introducing structural change in a contrac.ng fiscal environment, significant upfront cost ! " Very ambi.ous .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 ! " Perspec.ves of all stakeholders need to be considered in the overall design ! " Need to ensure open and fair compe..on between all providers ! " Pricing mechanism must reflect full economic cost (e.g., capital, pensions, etc.) 8 10/8/13 Universal Health Insurance: Opportuni.es, The Posives ! " Greater equity of access for paents ! " Broader Market/Single System ! " More equal compe..ve playing field ! " Beoer integraon (Capital Programmes, Service Strategies) ! " Promote high standards and efficiencies ! " Simplifies complex range of insurance plans Universal Health Insurance: Summary ! " Suppor.ve 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 ! " Transi.onal arrangements have poten.al to destabilise in short- medium term ! " Want to bring our resources and exper.se to bear to deliver healthcare reform 9 10/8/13 Alternave Models Catherine Whelan Chief Execu.ve, Independent Hospitals Associaon of Ireland Thank you to our sponsors SHRC LIMITED 10 .