Billy Kelleher (Cork North Central, Fianna Fail) | Oireachtas source

I welcome Mr. Joyce and Mr. Sloyan. Some key issues have to be addressed here. There is the immediate issue of the shorter and longer term policy decisions of the Government on universal health insurance and the potential difficulties that could arise in trying to implement that.

In terms of risk equalisation, intergenerational solidarity, community rating and all that is required to ensure we have a market that is not distorted by the fact that older people are more expensive and create a bigger liability on insurers, the inevitable cherry-picking of younger, healthier people is evident in the statistics of the various insurers but the most alarming aspect recently is the number of people who are dropping their health insurance cover and downgrading their plans. Mr. Joyce mentioned an annual 2% drop since 2008. The concern of insurers, and most policy makers, is the number of young people who are not taking up insurance. That is the key issue we must address to ensure we have a reasonably sustainable health insurance market in the short to medium term.

There are many reasons people drop out of health insurance cover. Affordability is the most obvious one in terms of the downturn in the economy, loss of jobs and so on but coupled with that is the massive health inflation. Will the witnesses indicate what are the main drivers in health inflation and what is the knock-on effect of that on premiums? Is it the policy decisions of Governments, the marketplace, consultant contracts or the charging of private insurers for the full cost of public beds? What is the breakdown in that regard? As someone who is involved in policy discussions I believe we can never find out that information. Insurers will tell us one thing, the Health Insurance Authority will tell us another and the Minister will tell us something else but we would like a breakdown as to the major contributory factors in the cost of premium increases. Is risk equalisation and community rating a factor? If so, that must be discussed.

We are in favour of risk equalisation, community rating and intergenerational solidarity but the difficulty is if people cannot afford to take out health insurance because this policy may be having an impact, it defeats the purpose because we have a law of diminishing return. We must get some detail on what is contributing to that in percentage terms or the sliding scale of priority downwards. The VHI, for example, has an older demographic. That is a simple fact of legacy, and it is confronted with difficulties on a daily basis. We are told that insurers from other countries coming here cherry-pick initially and hope that something happens in the future in terms of their clients' profile. That would be one of the key issues to be addressed.

On the broader issue of universal health insurance and the policies the Government is pursuing in that area, will Mr. Sloyan or Mr. Joyce outline the model that is working around the world that the committee, other policy and I should be advised to examine to try to identify a model that would fit into the policies the Government is pursuing? We are waiting for a White Paper on universal health insurance but I am not sure if anybody knows what they are meant to be doing in terms of identifying the model that will fit this country. We have four health insurers. There is one big player of the four. To have universal health insurance we must have quality competition in the marketplace but with a population of over 4 million people and the difficulties in the broader economy, I wonder if any more people will come into this marketplace to progress the universal health insurance idea the Minister is proposing.