Subsystems predated the introduction of the NHS and also coexist with a VHI market, which has grown in recent decades. Nonetheless, there are gaps in provision due to geographical imbalances and in practice the NHS does not cover dental care. User charges copayments are in place for most NHS services. Reforms in increased the level of user charges and the range of benefits to which they are applied see further on. A handful of VHI plans cover user charges for medicines. Insurers have never shown a real interest in assuming a substitutive role towards the NHS.
Most plans offer limited coverage, multiple exclusions apply for pre-existing, chronic and psychiatric diseases and few products cover individuals aged over 70 and at high risks. VHI premiums are based on risk, measured mainly by age and, to a lesser extent, by health status.
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It is very difficult for consumers to compare the prices and policy conditions of different VHI products. Insurers usually negotiate contracts with private hospitals and pay for private ambulatory care on a FFS basis. Several insurers use PPNs to minimize costs and increase efficiency, even though there is no evidence that this has been achieved. These networks do not generally require exclusivity and providers commonly belong to more than one network that is, with more than one insurer and may also hold contracts with the NHS, as well as provide private services to the general public on an OOP payment basis.
Typically, plans with PPNs involve user charges in the form of copayments, while coinsurance and balance billing are applied to plans that offer reimbursement. Some of the larger insurers have their own providers, giving them better control over costs and quality.
Services on Demand
In theory, the prices of services are negotiated between providers and insurers. However, since many providers depend on insurers to survive, their negotiating power is rather low. There is no VHI-specific legislation; general insurance legislation is applied to VHI, which is regulated by the following bodies: Tax incentives for companies and individuals have promoted the growth of the VHI market.
Since , tax reforms have made most private health care expenditure, including user charges for NHS services, OOP payments in the private sector and VHI premiums, deductible from personal taxable income — a policy that has had a substantial impact on VHI and private spending on health. It is still too early to estimate the impact of this change on the VHI market. However, relatively few businesses provide VHI for their employees.
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Since the s, the possibility of opting out of the NHS has been widely discussed in Portugal. As an experiment, between and some employees of Portugal Telecom, for whom a private health subsystem is in place, were allowed to opt out of the NHS. A small number of employees chose to do so. Because the NHS is funded through general taxation, this implied a transfer of a capitation fee by the NHS to the private subsystem, which then became responsible for paying the full price for NHS services whenever the beneficiary decided to use them.
However, the negotiation of this capitation fee proved to be extremely difficult and generated regular complaints by the subsystem, which argued that the amount was far too low. The subsystem eventually abandoned this model in Since then, opting out of the NHS has been allowed by law but no opting out has taken place.
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VHI has not generally attracted much public attention as it plays a marginal role in health financing. Direct and indirect incentives have favoured the development of the VHI market and increases in private spending, but there has been no serious discussion about the interaction between public and private coverage and spending. Access to VHI depends on the ability to pay, and demand for such products has mainly come from higher-income groups Nunes, The existence of a considerable share of the population enjoying double coverage through VHI as well as the NHS suggests that inequalities in access exist.
Many aspects of the VHI market would benefit from greater scrutiny by regulators. For instance, more attention should be paid to the conditions of annual contract renewal, since insurers do not always announce changes in prices or coverage in advance.
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In addition, there are some products in the market that, despite being similar to health insurance for example, insurance products associated with credit cards and dental health plans or products similar to those offered in some subsystems , are not covered by the jurisdiction of the Portuguese Insurance Institute Instituto de Seguros de Portugal.
Furthermore, in order to promote a transparent market and to protect consumers, prices, policy conditions and other relevant aspects of the VHI market should be monitored this is not currently the case. Be the first to review this item Would you like to tell us about a lower price? I'd like to read this book on Kindle Don't have a Kindle? Share your thoughts with other customers. Write a customer review. There's a problem loading this menu right now. Learn more about Amazon Prime. Get fast, free shipping with Amazon Prime.
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