Tag Archives: Ireland

Medical underwriting and risk adjustment practices: Ireland

Health insurance models vary from country to country. As highlighted in our first series of articles on international health markets, governments often dictate the role of private and public health insurance within any country. Milliman has produced a new series of blogs focused on the medical underwriting and risk adjustment practices of eight countries: Australia, Ghana, Ireland, New Zealand, Saudi Arabia, South Africa, Spain, and United Arab Emirates. This is the sixth article in our series.

The national public health system in Ireland provides access to health services to all people ordinarily resident in Ireland. The extent to which public health services are subsidized depends primarily on the means of the individual involved. Income limits are defined, varying by age category (higher limits apply for individuals over age 70 with some phasing in for the 66-69 age category). In addition, investments and other assets are notionally converted to income using predetermined income factors.

Individuals with total notional income below the relevant limits are entitled to a “medical card.” Medical card holders are entitled to free GP (family doctor) visits, prescribed drugs and medicines (with a nominal charge of 50 cents per prescribed item), public hospital services, dental services, maternity and infant health services, and a range of other services.

Individuals with total notional income above the relevant medical card limits, but below a defined higher limit, may be entitled to a “GP visit card.” The GP visit card is valid for a defined period of time and entitles the holder to free GP visits.

Individuals with weekly income exceeding the GP visit card threshold are not entitled to free GP visits and must pay for many of the services that are provided free to medical card holders, but many significant subsidies apply.

Continue reading