Martin Heydon (Kildare South, Fine Gael) | Oireachtas source

One of the key tenets of a just society must be equal and fair access to health services. One's ability to pay for services should not in any way determine the speed and level of access, which is the situation we currently have. People who can afford private health insurance may get access to a colonoscopy or mammogram or another procedure more quickly. The basis of universal health care is that those who can pay for health insurance will do so, while those who cannot will still get the same level of access.

Free general practitioner care for children has been discussed extensively in recent times. That is not an end in itself but is an important step on the road to universal health care. What we are facing is a series of steps that will ultimately lead to universal health care in 2019. Other measures that will be required along the way include the dissolution of the HSE and the establishment of the health care commissioning agency, the health care pricing office, the patient safety agency and provider trusts. There will also be a strengthening of the roles of the Health Insurance Authority, HIA, and the Health Information and Quality Authority, HIQA, and ultimately, by 2019, there will be universal health insurance.

Constituents have asked me what the impact will be on the different groups of people. They can be broken down into three groups. Holders of medical cards will see the waiting lists reduce sharply, allowing them timely access to key services. People who currently have no medical card and no private health insurance will have their premium heavily subsidised. Access to free GP care for those people and their children mean that they will probably be the biggest winners from the change.

Many people currently have private health insurance and they ask me if they will have to continue to pay for it but get less access to services. The key element in universal health care is the continuing reduction in waiting lists. It will be critical to ensure that this system works comprehensively. We must ensure that the existing benefits will continue for people who have private health insurance and continue to pay for it. Reducing the waiting lists is absolutely vital. In addition, there will be a reduced number of people on trolleys in emergency departments and reduced waiting times for outpatients, neither of which is covered by private health insurance at present. People with private health insurance will also get free GP care. People often put off visiting the doctor because it will cost them €55 to €60 per visit. The health problems often become manifest later as more serious illnesses which, if they had been dealt with in time, might have been more easily remedied. Free GP care, early access and early intervention will solve many issues that might later manifest themselves otherwise.

With regard to the reduction in waiting lists, the special delivery unit has achieved great progress. Some hospitals have installed new computer systems which has led to patients spending approximately 30% less time in hospital, thus freeing up beds and space for those who need them. There has been a reduction of 99% in the inpatient waiting list over eight months and a reduction of 95% in the outpatient waiting list over 12 months. This has taken place at a time when there is a 10% reduction in staff, a significant reduction in the budget and an 8% increase in the overall population.

Naas General Hospital in County Kildare is my local hospital. In 2011, the number of people on trolleys in that hospital was 4,409. In 2013, the figure had dropped to 1,842, a reduction of 58%. When one looks at the links between that hospital and St. Vincent's Hospital in Athy, which cares for older people, one can see the real benefits that filter down throughout the community when one tackles these waiting lists. That is key to improving our health service.

Reference has been made to our aging demographic. At present, Ireland is below the Organisation for Economic Co-operation and Development, OECD, average for population aged 65 years and over. Ireland's is 11% while the OECD average is 15%. Ireland's spending on health care is relatively high given our relatively young population. That is the reason the Government has been cutting costs in the health sector over the last few years. We now must prepare for an older population in the future. Previous Governments have shown that throwing money at this issue does not resolve it. We must make our health service more fit for purpose, more efficient and better value for money while continually improving the services that are delivered. The increased demand in the future will require major increases in taxation or significant cuts in services if we do not address the issue now. If we do not proceed with universal health care now, when do we do so? Continuing with the status quois not sustainable.

Under universal health insurance there will be a basket of general services. One's supplementary payment above that would pay for more luxurious accommodation or perhaps a private room but it will not impact on the level of service that is provided. That is absolutely key. The health care commissioning agency will be central in continuing to provide ambulance services and emergency departments. It will do that from general taxation and will pay directly for services that are not covered by universal health care.

Overall, universal health care is the way forward. There are huge challenges and pitfalls, but the challenges and pitfalls of doing nothing with our current health service as we face an aging demographic are far more frightening.

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