ADDRESSING MARKET SEGMENTATION AND INCENTIVES FOR RISK SELECTION: HOW WELL DOES RISK EQUALISATION IN THE IRISH PRIVATE HEALTH INSURANCE MARKET WORK? ESRI Research Bulletin 2017/05

Community rating restricts health insurers from varying premiums based on insurees’ risk profiles. It is a key feature of many health insurance markets. While designed to promote equity, this regulation incentivises insurers to focus on attracting low-risk (profitable) consumers while avoiding high-risk (unprofitable) consumers. This phenomenon is known as “risk selection”. Risk selection has a number of negative consequences, such as market segmentation and poor quality service to high-risk individuals (e.g. the old and sick). It also causes inefficiency where investment focusses on attracting low-risk individuals (e.g. the young and healthy) rather than improving price and quality. The best strategy for reducing risk selection incentives is good risk equalisation. Commonly, this involves providing risk-adjusted premium subsidies to insurers based on insurees’ risk profiles. These subsidies are generally administered through a risk equalisation scheme. Our study investigated the performance of Ireland’s scheme. Despite the liberalisation of the Irish health insurance market in the mid-1990s, bona-fide risk equalisation payments only commenced in 2013. The current risk equalisation system allocates risk-adjusted subsidies to insurers based on the age, sex, level of cover, and hospital utilisation, of insurees

SAFEGUARDING AMATEUR ATHLETES AN EXAMINATION OF PLAYER WELFARE AMONG SENIOR INTER-COUNTY GAELIC PLAYERS. RESEARCH SERIES NUMBER 99 December 2019

Following the publication of research into the commitments required of male Gaelic players to play senior inter-county, and knock-on effects of inter-county commitment (Kelly et al., 2018), the Gaelic Athletic Association (GAA) and Gaelic Players Association (GPA) established a working group to make an in-depth analysis of the report’s findings. One of the decisions taken by the working group was that further research was required to examine a range of issues that emerged from the original study. These included in particular: (i) the education and (ii) the professional career experiences of senior inter-county players, (iii) their engagement in risky behaviours (e.g. alcohol consumption), (iv) supplement usage, (v) players’ views on both provided and required supports, and (vi) what they would change about their experience of playing inter-county and the inter-county set-up

The introduction of lifetime community rating in the Irish private health insurance market: Effects on coverage and plan choice. ESRI Research Bulletin 202007 May 2020.

This study examines whether the introduction of lifetime community rating (LCR) in May 2015 encouraged individuals to take out health insurance to avoid paying late-entry premium loadings and the effect on plan choice

Baseline utilisation of specialist disability services in Ireland. ESRI Working Paper No.644 December 2019

The objective of this paper is to analyse the data on specialist disability services available in Ireland. The paper provides a baseline utilisation profile of selected services which can be used to project future service demand and expenditure. The limitations of the currently available data in providing a comprehensive picture of specialist disability services in Ireland are also outlined

COVID-19 hospital utilisation planning model: updated description and parameters. ESRI Report April 2021.

This technical note summarises the current version of the hospital service demand model that is used by the Irish Epidemiological Modelling Advisory Group (IEMAG) reporting to the National Public Health Emergency Team (NPHET)

Paying more to wait less: Estimating the cost of reducing Ireland’s public hospital waiting lists. ESRI Working Paper 688 December 2020.

Larger and longer waiting lists for public hospital appointments and treatment have been a significant challenge in Irish healthcare for decades. The issue has been further exacerbated by COVID-19 in 2020 with the cancellation of elective activity in public hospitals for several months. The aim of this analysis is to estimate the activity and expenditure required to clear the accumulated backlog and account for future service demand. We estimate that to clear the backlog of cases and keep pace with demand over a period of five years, additional expenditure excluding any associated capital costs of up to €1.1bn would be required

Utilisation of public acute hospital services in Ireland — Baseline analysis for the Hippocrates model. ESRI Survey and Statistical Report Series 100 December 2020.

The Hippocrates Model provides estimates and projections of public and private healthcare demand for a range of Irish health and social care services and has been extended to project capacity and expenditure for public hospital care. The first report from the Hippocrates Model, published in 2017, presented a baseline for projection based on data from 2015. This report updates that baseline analysis using 2018 data. Using a range of administrative data sources, the report provides age and sex utilisation profiles for public acute hospital services. It covers emergency department and outpatient department attendances, and day-patient and in-patient discharges

Hospital admission probability and length of stay among Covid-19 confirmed cases. ESRI Report February 2021.

The volumes of Covid-19 confirmed cases and hospital admissions have varied across the course of the pandemic in Ireland. Three broad waves can be identified; March through July, August through November, and December onwards. The majority of confirmed cases and hospital admissions have been recorded since December. This briefing note examines how the relationship between cases, hospital and critical care admissions, and hospital length of stay, may have varied over the course of the pandemic. Particular attention is paid to variation in age-specific distributions of admission probabilities and average length of stay across waves of the pandemic

COVID-19 hospital utilisation planning model: Description and parameters. ESRI Technical Paper February 2021.

This technical note summarises the current version of the hospital service demand model that is used by the Irish Epidemiological Modelling Advisory Group (IEMAG) reporting to the National Public Health Emergency Team (NPHET). The model is continually updated, so this note supersedes previous versions, and will be superseded by future updates

Addressing market segmentation and incentives for risk selection: how well does risk equalisation in the Irish private health insurance market work?

This study assesses the efficacy of Ireland’s recently introduced risk equalisation scheme in its voluntary health insurance market. Robust risk equalisation is especially important in an Irish context given acute risk segmentation and incentives for risk selection that have evolved within the market. Using uniquely acquired VHI data (N=1,235,922) this analysis assesses the predictive efficacy of both current and alternative risk equalisation specifications. Results suggest that the low predictive power of the current risk equalisation design (R2 = 6.8 per cent) is not appropriately correcting for anti-competitive incentives and asymmetries in the market. Improvements to the current design could be achieved through the introduction of diagnosis-based risk adjusters