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 Header Item Health Insurance (Amendment) Bill 2017 [Seanad]: Second Stage (Resumed) (Continued)
 Header Item Estimates for Public Services 2017: Message from Select Committee

Wednesday, 6 December 2017

Dáil Éireann Debate
Vol. 962 No. 7

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(Speaker Continuing)

[Deputy Róisín Shortall: Information on Róisín Shortall Zoom on Róisín Shortall] Obviously, over recent years, many gave it up. During the austerity years, the level of cover went down to its lowest and it is gradually creeping up again, with 46% of people currently having it. As I said to the Minister last week, I would see this 46% who feel that they must have private health insurance out of fear and out of a lack of confidence in the public health system as a serious indictment of the health system. This is unheard of in most other European countries. Generally, in European countries, people have access to an affordable public health system that is generally free or almost free at the point of use and that is the kind of system we should have in this country. It is the kind of system that Irish people should be entitled to. Unfortunately, we are in a situation where nearly half the population feel they must fork out for very expensive insurance.

I spoke last week about the average premium. I do not accept the average premium figures provided. The average premium for a person over 50 on the basic plan B is €2,000 this year. It had been €1,500 last year. That has to be seen for what it is. It is essentially another tax for people. It is an additional tax of €38 a week or €167 per month to buy private health insurance. If the recent budget had announced the introduction of new taxes of €167 a month, the Government would be laughed out of it, but somehow people seem to think it is all right to put this kind of charge or tax on people just to access basic health cover. Of course, what people get from the basic plan B is basic health cover. It really only enables people to skip the queue and jump ahead of others who do not have private health insurance when it comes to elective surgery.

By and large, the health insurance policies that are available in this country give poor value for money. In addition to paying that €2,000 a year for private health insurance, people are also caught with paying usually the full cost of a GP. A consultant can cost €220 and a person enjoys little cover from his or her health insurance for that. Private health insurance does not cover medicines. In the main, it does not cover any diagnostics. It also does not cover emergency department access. No doubt people are being ripped off. They are faced with this considerable additional bill just so that they can have some peace of mind that if they have an emergency, or not so much have an emergency but need elective surgery, they will be able to access that in a timely way.

As I said, we are having the wrong debate here. The debate we need to be having is how we move from the current dysfunctional, unfair, inequitable and inefficient two-tier health system to a single-tier public health system comparable to most other countries. That is what all of the emphasis should be on at this point. If the Minister ever needed proof that the present system is so wrong, all he need do is look at the "RTÉ Investigates" programme to see the kind of carry-on there and the blatant abuse of the two-tier system. I suppose events have overtaken that shocking programme but we still need answers to what Deputy Harris, as Minister, will do about the revelations shown in that programme. At the recent Joint Committee on Health, the Minister spoke about pursing the cases that were highlighted in that programme, but of course the fact is that this is a systemic problem in many parts of the country, in particular in hospitals. I will undertake to send on to the Minister tomorrow details of that information that was drawn up by the "RTÉ Investigates" programme.

Deputy Simon Harris: Information on Simon Harris Zoom on Simon Harris I thank Deputy Shortall.

Deputy Róisín Shortall: Information on Róisín Shortall Zoom on Róisín Shortall They only covered the surveillance of a small number of consultants but the reality is that there are large numbers of consultants abusing the system like this and really gaming the system. That has to be dealt with. We are not getting good value for the significant spend that the taxpayer makes on health, nor are we getting value for money in any way, whether it is in the public system or the private system, and that must be addressed.

Are we on time, a Cheann Comhairle?

An Ceann Comhairle: Information on Seán Ó Fearghaíl Zoom on Seán Ó Fearghaíl We are out of time but we might conclude. Does the Deputy have much further to go?

Deputy Róisín Shortall: Information on Róisín Shortall Zoom on Róisín Shortall I am happy to conclude my comments.

An Ceann Comhairle: Information on Seán Ó Fearghaíl Zoom on Seán Ó Fearghaíl Perhaps we might ask the Minister to respond.

Deputy Róisín Shortall: Information on Róisín Shortall Zoom on Róisín Shortall The bigger picture has to be addressed because it is not sustainable.

Minister for Health (Deputy Simon Harris): Information on Simon Harris Zoom on Simon Harris I thank Deputies for their support for this Bill and their contributions to the debate.

I agree with Deputy Shortall, in terms of the debate that we need to be having and, indeed, the debate we are having. This is obviously annual legislation we deal with but the Deputy is quite correct. We have all subscribed in this House to the idea of creating a universal health care system that can provide timely access for patients based on need, not ability to pay. That is where I want to get to as well. In that regard, Deputy Shortall has shown leadership with the Sláintecare report on which I look forward to working with Deputies in this House.

To recap briefly, the main purpose of this Bill is to specify the revised risk equalisation credits and the corresponding stamp duty levies to apply on health insurance from April of next year. I am pleased that this year it has been possible to maintain the main stamp duty at the existing level. In addition, the stamp duty for non-advanced contracts is being reduced by 20%. The credits and levy rates for next year strike a fair balance between the need to sustain community rating by keeping health insurance affordable for older less healthy consumers and maintaining the sustainability of the market by keeping younger healthier customers in the market.

The Bill also makes a number of changes to the operation of the lifetime community rating to ensure the continued smooth operation of that scheme in a fair and balanced manner. Following enactment of this Bill, I will make a regulation next year which will set out specific details of the changes and will further enhance the operation of the lifetime community rating scheme. These changes, coupled with ongoing increases in employment, which is factually a key driver in the demand for health insurance, will support the market and everyone who wishes to purchase private health insurance.

Before concluding, I will briefly respond to a few questions that were raised in this debate. Deputy Kelleher mentioned that the public health system subsidises consultants to do additional work over and above what they are entitled to do. A key objective of the consultant contract of 2008 is to improve access for public patients to public hospital care. The responsibility for reporting individual consultants' compliance with their contract was formally delegated to hospital groups in 2014. However, it appears clear that these arrangements are not robust enough to ensure individual consultant compliance. My Department is working with the HSE to find a solution to ensure compliance is monitored more effectively. I look forward to receiving that detail from Deputy Shortall tomorrow and passing it on to the HSE, and seeking action upon it.

Deputy Boyd Barrett queried whether the report prepared by the Health Insurance Authority, HIA, will be published. I can confirm that the report will be published before Committee Stage takes place.

Deputy Mattie McGrath asked had I met the Health Insurance Authority. I most recently met it on Thursday, 26 October.

  Question put and agreed to.

  Committee Stage ordered for Tuesday, 12 December 2017.

Estimates for Public Services 2017: Message from Select Committee

An Ceann Comhairle: Information on Seán Ó Fearghaíl Zoom on Seán Ó Fearghaíl The Select Committee on Business, Enterprise and Innovation has completed its consideration of the following Estimate for public services for the service of the year ending on 31 December 2017: Vote 32 - Business, Enterprise and Innovation (Supplementary).

  The Dáil adjourned at 10.20 p.m. until 10.30 a.m. on Thursday, 7 December 2017.

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