Alternative health insurance: “We’ll pay for anything!”

Paul O’Donoghue, writing in the Irish Times on Sept. 9th http://www.irishtimes.com/newspaper/sciencetoday/2010/0909/1224278501793.html , draws attention to the minor scandal that is wasting health insurance on silliness. I too have been exercised about this. Quite some time ago I complained to the VHI. My point essentially is that medical insurers, in paying for reflexology and the like, are saying one of two things: that these practices are medical treatments within the meaning of the Act, or that medical insurers can pay out for anything they wish. Moreover, VHI approval confers status – a degree of official medical approval which these practitioners crave.

VHI assured me that their decision to pay conferred no recognition that reflexology etc. were medical treatments. The decision to pay was determined solely by competition. In other words, if there is a competitive advantage in listing a practice for payment, it could happen; medical and scientific considerations are irrelevant.

Given that VHI is one operator in a market, I was sympathetic to their position and turned my attention to the regulator, The Health Insurance Authority. My point was essentially unchanged. If the Regulator, as guardian of the Acts, allows payment to be made for Reflexology and the like, the Regulator defines them as medical treatments. Response was swift and brief: the VHI and others were acting legally but this did not mean that the Regulator accepted that reflexology etc. were medical treatments. I tried many times to point out that unless the Regulator had a compelling argument, this is precisely what the decision meant. The thinking behind the Regulator’s decision was withheld and I had to change tack.

I asked for the matter to be put to the Authority, the board, for their consideration. I had been testing this form of citizen initiative for some time and to the credit of the HIA, I received full and friendly cooperation. I was aware that no one on the Authority had a medical or science background and assumed that there would be delay as they sought professional advice.

It would appear that the advice sought was legal and the advice – accepted by the HIA – is that health insurers can pay for reflexology etc. as long as they first provide adequate medical cover under the “Minimum Benefits Regulations”. This brings me back to where I started. If this stands, “medical treatment” in the Act is either meaningless or can be ignored once basic provision has been established. This produces a bizarre outcome whereby a health insurer can pay for reiki, Hopi ear-candling or indeed replacement windows!

It is clear that the intention of the legislation was to confine payment to medical treatments. It is equally clear that the intention of later minimum-benefit regulation was certainly not to permit payments for other than medical treatments. It is clear too that VHI do not consider reflexology a medical treatment. It is the HIA’s position, supported by legal advice, that control can be exercised over only “prescribed minimum benefits”. Beyond these, health insurers are not limited to making payments for medical treatments only and the HIA accepts no role in determining what is or is not included in a health insurance contract.

The basic problem remains. Payment by a medical insurer IS recognition that something is a medical treatment. It is more than a matter of practitioners having access to insurance funds; it is about official sanction. Uncomfortable or not, health insurers and the HIA are effectively a part of the medical establishment.