Voluntary Health Insurance Board, Institute of Public Administration, Dublin, Ireland.
Health Policy. 2010 Nov;98(1):15-26. doi: 10.1016/j.healthpol.2010.06.010. Epub 2010 Jul 24.
Ireland has a system of private health insurance (PHI) which acts as a voluntary alternative to the benefits provided under the Irish public health system. As part of this, community rating has long been a cornerstone of the Irish private health insurance market with the objective to make PHI affordable to everyone regardless of their risk profile. Until the mid-1990s one insurer had a legal monopoly. However, in 1996, following the Third Non-Life Insurance Directive, the market was opened up to competition and a number of regulations were introduced to support community rating. This includes the introduction of a risk equalisation system. Its aim was to prevent selection and thus protect the community rating system while still enabling a competitive health insurance market. There have been significant obstacles to the introduction of risk equalisation due to political, legal and implementation issues. The objective of this paper is to review the history, structure and likely effectiveness of risk equalisation in Ireland. The paper provides lessons for other countries with risk equalisation systems or seeking to introduce such a system. Amongst other conclusions, it outlines the difficulties in introducing risk equalisation.
爱尔兰有一个私人医疗保险（PHI）系统，作为爱尔兰公共卫生系统提供的福利的自愿替代方案。作为其中的一部分，社区评级长期以来一直是爱尔兰私人医疗保险市场的基石，其目标是使每个人都能负担得起私人医疗保险，无论其风险状况如何。直到 20 世纪 90 年代中期，一家保险公司才拥有合法的垄断地位。然而，1996 年，在第三次非寿险指令之后，市场向竞争开放，并引入了一些法规来支持社区评级。这包括引入风险均等化系统。其目的是防止选择，从而保护社区评级系统，同时仍然能够使健康保险市场具有竞争力。由于政治、法律和实施问题，引入风险均等化存在重大障碍。本文的目的是回顾爱尔兰风险均等化的历史、结构和可能的效果。本文为其他有风险均等化系统或寻求引入这种系统的国家提供了经验教训。除其他结论外，它还概述了引入风险均等化的困难。
