Competition in the Irish Private Health Insurance Market

The Supply of Private Medical Facilities
7.13 Of the 50 private medical facilities covered by PHI firms in Ireland,
around half are in-patient hospitals of substantial variation in size, and
20% are treatment or addiction centres. The remaining 30% includes
dental clinics, laser eye clinics, cosmetic surgery facilities, addiction
treatment centres, imaging facilities, diagnostics and pathology-related
testing and respite care. 114 There are less than 10 major private
hospitals in the State outside of Co. Dublin of which 5 are controlled by
the Bon Secours organisation. Dublin and Galway are the only
counties to have more than one major private hospital. The Irish
private hospital sector is relatively underdeveloped, and most private
treatments are still delivered in public facilities, in part because,
according to the OECD, PHI firms have not supported private hospital
capacity increases. 115
7.14 Apart from geographical submarkets, there are a number of other
niche markets in which private hospitals are involved. For example
there are only a limited number of private psychiatric hospitals, only
the Mount Carmel in Dublin provides private maternity services and the
Blackrock Clinic and Mater Private would also be in a separate niche
market.
7.15 In order to determine the likelihood of buyer power, it is necessary to
assess the different categories of private healthcare buyers. Private
bed in-patient stays are paid for by:
• the patients themselves (“self-payers”)
• the open enrolment health insurers
• the restricted membership schemes (ESB, Gardaí, Prison Officers)
• the State, funding the National Treatment Purchase Fund (NTPF).
7.16 Self-payers, the NTPF and the restricted membership schemes all
contribute small proportions to the overall demand for private
healthcare.
• Given the cost of surgical procedures, relatively few patients pay
for their own treatment. 116 Self-payers therefore provide a
relatively small proportion of demand.
• The National Treatment Purchase Fund (NTPF) was established in
2002 to expedite procedures for individuals on long-term waiting
lists. In 2005, it paid for the treatment of 18,197 patients. 117 16
private hospitals in Ireland participate in the NTPF. 118 90% of NTPF
referrals are to private hospitals, and 95% of these are to private
hospitals in Ireland. This suggests that the NTPF paid for the
114 A full list of facilities covered by Irish PHI firms is included in Appendix 4.
115 OECD (2004a), p.177
116 OECD (2004) p.35
117 NTPF Annual Report (2005), p.5. Available online at
http://www.ntpf.ie/news/NTPF%20Ann.Report%202005.pdf
118 These are the Bon Secours hospitals in Dublin, Cork, Tralee and Galway, the Blackrock and Galway
Clinics, Garden Hill, Sligo (St. Joseph’s), Barringtons Hospital, Limerick, Aut Even, Kilkenny, Clane
General Hospital, St. Francis Hospital, Ballinderry, Shanakiel Private Hospital, Cork and Northbrook
Clinic, Mount Carmel, St. Vincent’s Private Hospital and the Mater Private Hospital, all in Dublin.
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