Show simple item record

dc.contributor.authorRYAN, PADHRAIGen
dc.date.accessioned2016-06-22T12:19:54Z
dc.date.available2016-06-22T12:19:54Z
dc.date.issued2014en
dc.date.submitted2014en
dc.identifier.citationMikkers, M., Ryan, P., "Managed competition" for Ireland? The single versus multiple payer debate, BMC Health Services Research, 14, 1, 2014en
dc.identifier.otherYen
dc.identifier.urihttp://hdl.handle.net/2262/76583
dc.descriptionPUBLISHEDen
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.; 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 performanceen
dc.relation.ispartofseriesBMC Health Services Researchen
dc.relation.ispartofseries14en
dc.relation.ispartofseries1en
dc.rightsYen
dc.subjecthealth policyen
dc.title"Managed competition" for Ireland? The single versus multiple payer debateen
dc.typeJournal Articleen
dc.type.supercollectionscholarly_publicationsen
dc.type.supercollectionrefereed_publicationsen
dc.identifier.peoplefinderurlhttp://people.tcd.ie/ryanp6en
dc.identifier.rssinternalid110275en
dc.rights.ecaccessrightsopenAccess
dc.identifier.orcid_id0000-0001-7852-5606en


Files in this item

Thumbnail

This item appears in the following Collection(s)

Show simple item record