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Home / Bay of Plenty Times

Crisis of health insurance affordability

Bay of Plenty Times
30 May, 2015 08:11 PM4 mins to read

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Raewyn Andrews spent a year in pain waiting for a knee replacement because she could no longer afford her increasing health insurance premiums. Photo / Andrew Warner

Raewyn Andrews spent a year in pain waiting for a knee replacement because she could no longer afford her increasing health insurance premiums. Photo / Andrew Warner

Raewyn Andrews spent a year in pain waiting for a knee replacement because she could no longer afford her increasing health insurance premiums.

Mrs Andrews is not alone and insurance companies have admitted health insurance affordability is an issue for New Zealanders, especially as they get older.

At the most extreme, a 73-year-old non-smoking couple with no pre-existing medical conditions could be paying more than $1000 per month in premiums, a 2014 Consumer NZ survey revealed.

Mrs Andrews and her husband cut back their health insurance premiums as much as possible before they eventually cancelled their policies.

First they eliminated basic cover for GPs and dental, then they cancelled Mr Andrews' cover in 2003 as he rarely claimed on it, before increasing Mrs Andrews' excess to $2000, dropping down her premium to $63 per month.

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Mrs Andrews claimed two hip replacements under insurance and figured it was better to cancel her policy in 2010 and put the same amount into a savings account every month.

However, within three years, her knee gave out and she needed a replacement - but had to wait more than a year.

"It's a difficult choice because you never know what's ahead of you.

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"I could still walk around but my knee was collapsing on me ... I had to give up all the activities I was in ... So I basically had two years of hell or misery."

A specialist was worried that Mrs Andrews would have a fall and damage her new hips.

"The specialist told me I wasn't bad enough to go on the public waiting list but I was bad enough to get it done ... You've got to be crawling on the floor like a cripple for them to put you on the list."

Unfortunately, health insurance was financially no longer an option.

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Accuro Health Insurance chief executive Geoff Annals said insurers were working with a "failed model".

"The people who have the highest needs for treatment services are mostly the same people who have the poorest access to publicly funded services. Finally these are the very people least able to pay for their own private health insurance."

Premiums at every age were calculated to cover the cost of claims paid out for the same age group, he said.

"Access to the right health care at the right time should not be a luxury but sadly, for many it is a need they cannot meet. And that is true not just for older people on fixed incomes. Most New Zealanders, around 70 per cent, do not have health insurance."

A company concern was the increasing cost of medical procedures which directly affected the cost of claims and therefore pushed up premiums.

Accuro's claims costs increased by 42 per cent between 2010 and 2013.

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Matthew Neat, of nib Health Funds, said health insurance affordability was a real issue for the New Zealand health system.

"Due to the structure of the New Zealand health system, it's unfortunate that as people become older their premiums typically cost more.

"There are ways in which we as an industry - with the help of Government - we can make changes to ensure private health insurance is affordable for all New Zealanders and not regarded as a luxury item ... We think there is an opportunity to look at more fundamental industry structural changes, such as encouraging younger people to take out private health insurance, which will reduce overall industry claims inflation and make premiums for the elderly more affordable."

Southern Cross Health Society chief executive Peter Tynan acknowledged it was difficult for members to afford premiums once they retired.

Southern Cross, which covers 61 per cent of New Zealanders who have health insurance, offered lower premiums for reduced cover.

Nevertheless, it was an inescapable fact that increasing claims costs increased premiums, he said.

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