Competition in the Irish Private Health Insurance Market

present contrasting experiences in this regard, as New York implemented its PHI
community rating reforms rapidly, whereas Vermont phased in their
implementation, with less resulting instability (White, 1994).
128. A second approach to PHI affordability is the imposition of caps on the
premiums of coverage that must be issued to high-risk persons. Both Germany
and the Netherlands limit primary PHI premiums in this way for their standard
PHI packages. In both cases,….
129. Additional regulatory tools can bolster the effectiveness of access and
premium-related requirements. For example, renewability requirements, such as
exist in Ireland and the United States, among other countries, are a useful and
fairly straightforward means of promoting continuity of coverage and risk pooling.
Under such….
130. Access-related standards pose particular challenges as they are inextricably
intertwined with affordability challenges – which are linked to broader health care
cost-control concerns. They also confront one of the most difficult aspects of PHI
markets – the tendency for insurers to try to select “good risks” and avoid “bad”
ones and the tendency for individuals in good health to prefer less expensive, less
generous coverage, or not to purchase coverage at all.
“Regulation can improve consumer confidence in PHI markets”
131. Governments can shape the scope of PHI markets by imposing standards or
limits on the benefits that PHI insurers can offer. Again, policymakers within
OECD countries have generally adopted interventions falling into two broad
categories.
132. First, they can specify required benefits through minimum benefit standards,
as in Ireland, Australia, and many US states. These standards have the
advantage of spreading the burden of covering certain higher cost benefits across
insurers, and helping governments link PHI with health promotion goals.
133. A second approach to regulating benefits, and promoting product
comparability, is the requirement that insurers offer a limited number of specified
benefit packages. This approach….
134. Disclosure requirements can work together with benefit standards to
promote and reinforce consumers’ understanding of their PHI products and
coverage options. In recognition of the complexity and uniqueness of certain
issues arising within private health coverage markets, several OECD countries
developed and impose health insurance specific disclosure standards (e.g.
Australia, Portugal, Germany, Mexico and the United States)…..
135. Consumer confidence in PHI markets and their coverage can also be
strengthened by mechanisms which provide policyholders with cost-free or lowcost
means to appeal certain plan decisions ….
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