"Managed competition" for Ireland? The single versus multiple payer debate.

Hdl Handle:
http://hdl.handle.net/10147/583457
Title:
"Managed competition" for Ireland? The single versus multiple payer debate.
Authors:
Mikkers, Misja; Ryan, Padhraig
Citation:
"Managed competition" for Ireland? The single versus multiple payer debate. 2014, 14:442 BMC Health Serv Res
Publisher:
BMC health services research
Journal:
BMC health services research
Issue Date:
Sep-2014
URI:
http://hdl.handle.net/10147/583457
DOI:
10.1186/1472-6963-14-442
PubMed ID:
25261074
Abstract:
A persistent feature of international health policy debate is whether a single-payer or multiple-payer system can offer superior performance. In Ireland, a major reform proposal is the introduction of 'managed competition' based on the recent reforms in the Netherlands, which would replace many functions of Ireland's public payer with a system of competing health insurers from 2016. This article debates whether Ireland meets the preconditions for effective managed competition, and whether the government should implement the reform according to its stated timeline. We support our arguments by discussing the functioning of the Dutch and Irish systems.; Although Ireland currently lacks key preconditions for effective implementation, the Dutch experience demonstrates that some of these can be implemented over time, such as a more rigorous risk equalization system. A fundamental problem may be Ireland's sparse hospital distribution. This may increase the market power of hospitals and weaken insurers' ability to exclude inefficient or poor quality hospitals from contracts, leading to unwarranted spending growth. To mitigate this, the government proposes to introduce a system of price caps for hospital services.The Dutch system of competition is still in transition and it is premature to judge its success. The new system may have catalyzed increased transparency regarding clinical performance, but outcome measurement remains crude. A multi-payer environment creates some disincentives for quality improvement, one of which is free-riding by insurers on their rivals' quality investments. If a Dutch insurer invests in improving hospital quality, hospitals will probably offer equivalent quality to consumers enrolled with other insurance companies. This enhances equity, but may weaken incentives for improvement. Consequently the Irish government, rather than insurers, may need to assume responsibility for investing in clinical quality. Plans are in place to assure consumers of free choice of insurer, but a key concern is a potential shortfall of institutional capacity to regulate managed competition.; Managed competition requires a long transition period and the requisite preconditions are not yet in place. The Irish government should refrain from introducing managed competition until sufficient preconditions are in place to allow effective performance.
Item Type:
Article
Language:
en
Description:
A persistent feature of international health policy debate is whether a single-payer or multiple-payer system can offer superior performance. In Ireland, a major reform proposal is the introduction of 'managed competition' based on the recent reforms in the Netherlands, which would replace many functions of Ireland's public payer with a system of competing health insurers from 2016. This article debates whether Ireland meets the preconditions for effective managed competition, and whether the government should implement the reform according to its stated timeline. We support our arguments by discussing the functioning of the Dutch and Irish systems.
Keywords:
HEALTH INSURANCE; HEALTH ECONOMICS
MeSH:
Health Care Reform; Insurance, Health; Ireland; Managed Care Programs; Netherlands; Policy Making; Quality of Health Care; Single-Payer System
ISSN:
1472-6963

Full metadata record

DC FieldValue Language
dc.contributor.authorMikkers, Misjaen
dc.contributor.authorRyan, Padhraigen
dc.date.accessioned2015-12-09T09:46:40Zen
dc.date.available2015-12-09T09:46:40Zen
dc.date.issued2014-09en
dc.identifier.citation"Managed competition" for Ireland? The single versus multiple payer debate. 2014, 14:442 BMC Health Serv Resen
dc.identifier.issn1472-6963en
dc.identifier.pmid25261074en
dc.identifier.doi10.1186/1472-6963-14-442en
dc.identifier.urihttp://hdl.handle.net/10147/583457en
dc.descriptionA persistent feature of international health policy debate is whether a single-payer or multiple-payer system can offer superior performance. In Ireland, a major reform proposal is the introduction of 'managed competition' based on the recent reforms in the Netherlands, which would replace many functions of Ireland's public payer with a system of competing health insurers from 2016. This article debates whether Ireland meets the preconditions for effective managed competition, and whether the government should implement the reform according to its stated timeline. We support our arguments by discussing the functioning of the Dutch and Irish systems.en
dc.description.abstractA persistent feature of international health policy debate is whether a single-payer or multiple-payer system can offer superior performance. In Ireland, a major reform proposal is the introduction of 'managed competition' based on the recent reforms in the Netherlands, which would replace many functions of Ireland's public payer with a system of competing health insurers from 2016. This article debates whether Ireland meets the preconditions for effective managed competition, and whether the government should implement the reform according to its stated timeline. We support our arguments by discussing the functioning of the Dutch and Irish systems.en
dc.description.abstractAlthough Ireland currently lacks key preconditions for effective implementation, the Dutch experience demonstrates that some of these can be implemented over time, such as a more rigorous risk equalization system. A fundamental problem may be Ireland's sparse hospital distribution. This may increase the market power of hospitals and weaken insurers' ability to exclude inefficient or poor quality hospitals from contracts, leading to unwarranted spending growth. To mitigate this, the government proposes to introduce a system of price caps for hospital services.The Dutch system of competition is still in transition and it is premature to judge its success. The new system may have catalyzed increased transparency regarding clinical performance, but outcome measurement remains crude. A multi-payer environment creates some disincentives for quality improvement, one of which is free-riding by insurers on their rivals' quality investments. If a Dutch insurer invests in improving hospital quality, hospitals will probably offer equivalent quality to consumers enrolled with other insurance companies. This enhances equity, but may weaken incentives for improvement. Consequently the Irish government, rather than insurers, may need to assume responsibility for investing in clinical quality. Plans are in place to assure consumers of free choice of insurer, but a key concern is a potential shortfall of institutional capacity to regulate managed competition.en
dc.description.abstractManaged competition requires a long transition period and the requisite preconditions are not yet in place. The Irish government should refrain from introducing managed competition until sufficient preconditions are in place to allow effective performance.en
dc.language.isoenen
dc.publisherBMC health services researchen
dc.rightsArchived with thanks to BMC health services researchen
dc.subjectHEALTH INSURANCEen
dc.subjectHEALTH ECONOMICSen
dc.subject.meshHealth Care Reformen
dc.subject.meshInsurance, Healthen
dc.subject.meshIrelanden
dc.subject.meshManaged Care Programsen
dc.subject.meshNetherlandsen
dc.subject.meshPolicy Makingen
dc.subject.meshQuality of Health Careen
dc.subject.meshSingle-Payer Systemen
dc.title"Managed competition" for Ireland? The single versus multiple payer debate.en
dc.typeArticleen
dc.identifier.journalBMC health services researchen
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