Liam Twomey (Wexford, Fine Gael) | Oireachtas source

It is definite that the debate and the consultation on this issue will continue over the next few months. I hope we get an opportunity to engage in a clear debate, as opposed to merely making statements, on what is being proposed.

Any policy change can be undermined by the fear of the unknown and the perception of what it might mean for the individual. Trust will always be a huge issue in any political system. There are people who disagree with or have concerns about the changes that were made to the Dutch system. Concerns have been raised about the German system. I remind those who are promoting the Swedish model of care as the one this country should be aiming for that huge concerns were raised when Sweden was introducing major reforms and changes. Sinn Féin seems to support the NHS model as the ideal system for this country, but anyone with the most basic reading skills will understand that huge concerns have been raised about the way some reforms have been carried out under the NHS system. No one seems to be talking about the model used in Denmark, which underwent a huge amount of reorganisation in recent years. It was all done by consensus. It seems to be the reform that created the fewest difficulties for the citizens of the country in question.

There has been a great deal of talk about the Dutch model during this debate. It has been mentioned that a decade after it was first implemented, the Dutch system now costs twice as much as the old system did. Given that our health expenditure has more than doubled over the same period of time, it is funny that no one is queueing outside Hawkins House to seek to replicate the system we have been using for the last decade. It is even stranger when one considers that Fianna Fáil, which is pointing out the flaws in the Dutch model, was responsible for doubling our expenditure on our own system.

There are huge issues we need to discuss and of which we need to be aware . The cost of the VHI in this country could easily increase by 40% or 50% over the next five or six years because of the way it is structured at the moment. High demand older patients are holding on to their private health insurance by their fingernails, whereas low demand younger patients let go of their health insurance a long time ago. That sort of instability in our private health system could sink the VHI and many of the other insurance companies operating in this country. That might not bother Sinn Féin, as the tone of its Deputies' contributions to this debate suggests it probably wants to get rid of private health insurance in this country by abolishing it completely. That is a policy decision for that party to make for itself.

The public debate on this initiative should not yet focus on the basket of services that will be available. We should not focus on the cost of universal health insurance. While these issues are important, it is far too early to be discussing them as if they were the main issues we should be discussing now. It has been pointed out that it will be necessary to follow a number of stepping stones as we pave the way for the introduction of universal health insurance. If we can manage the public perception of how these stepping stones are being followed, that will help to reduce the level of concern about what we are doing. Therefore, the focus should remain on the stepping stones that relate to the reforms that are being carried out at present.

The special delivery unit has reduced the waiting times of patients in accident and emergency departments and the waiting times of those waiting for outpatient appointments. Deputy Shortall said that the figures are skewed because these reductions relate solely to those who have been waiting for a long time. She suggested that people in the mid-range, as she called it, are waiting longer. The current approach is working. It has reduced waiting times. People used to have wait up to four years to see ear, nose and throat and orthopaedic consultants. I ask the Minister to go a bit further. There are many problems with the way the system works in this country. I do not think it matters whether we introduce the multi-payer model or any other model that has been proposed.

There is a sense of secrecy about all the systems that operate in this country. In addition to driving reforms, the Minister must aim to improve transparency and provide more information. If we are to talk about a patient-centred health service, we must ensure everything is centred on patients. It should be possible for a patients to look up hospital websites to see how long they will have to wait to see consultants. As a doctor, I cannot find out from a hospital how long a patient will have to wait to see a hospital consultant. It sounds fairly rudimentary. It sounds like the simplest thing in the world to do, but we cannot do it.

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