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

I apologise for having ducked out of the meeting, thereby missing some of the presentations, but I believe my questions will relate to all four insurers represented here today. I thank the witnesses for their attendance. Towards the end of his presentation, Mr. Clancy referred to incentivising people to get into the private health insurance market. While the easiest part is saying that, I seek information on what steps could be taken to incentivise people to join private health insurance. When referring to risk equalisation, I assume that all insurers are of the opinion that risk equalisation is essential and necessary in a civilised society in which there is intergenerational solidarity and dependency. At the same time, however, I refer to a concern shared by many members, who could not get these answers from the Health Insurance Authority. In respect of older people obviously costing insurers more, it is clear that if we continue as we are, premiums will escalate continually. We should be honest about this and the risk equalisation measures being proposed will further exacerbate this issue. Thereafter, one will have a continual falling out of younger people from the insurance market, which will perpetuate the price spiral to which Mr. Clancy referred.

The key question for the insurers is what policy decisions should be made that would reduce the cost to insurers for public beds, for example. I refer to the full costs being recouped for private patients in public beds. As for the €125 million that was being paid upfront by the insurers to address the budget deficit for this year, it appears that within a matter of days of this measure being announced, it also was indicated that the cost of premiums would increase. Is this a sort of quid pro quo for an upfront payment? In itself, this would mean that it is not the insurers but the policyholders who are plugging the gap in the deficit. I invite witnesses to address this issue when making their concluding remarks.

Primarily however, risk equalisation is an accepted practice and this is legislation that will come before the Dáil. What impact do the witnesses believe it will have on the cost of providing health cover for people? Will it act as a further disincentive? Very few people are telling me what, as policymakers, members can do to incentivise people to take up private health insurance. Clearly, this is the key issue if we are trying to move to a universal health insurance model.

There is a perception that moving to a universal health insurance model will be almost free for everybody, but there will be a huge cost in providing it. This idea that it is almost free to us all and that few people will be paying for it, is erroneous. The fact is that, as it stands, those who have private health insurance will be contributing an awful lot more to provide universal health insurance. They are contributing through general taxation. If one moves to the model that is being discussed, I am concerned that there would be major increases for people who have private health insurance, both directly and indirectly in terms of taxation.

Has any analysis been done by various insurers on the potential cost of universal health insurance to their clients? I know we are slightly talking in the dark because we are waiting for a commission to report on universal health insurance and what type of model will be adopted. That will certainly generate much further discussion but it remains an area of concern.

As regards providers, I was always under the impression that more competition in the marketplace would drive down costs. There seems to be a view among some health insurers that the fewer facilities that are available the better it is for them. I thought that the more hospitals that came on stream, together with competition between public and private facilities, would ultimately be good for insurers. However, there is a view among some insurers that the fewer hospitals they have the better. What is the reasoning or logic behind that?

Senator Colm Burke referred to a hospital in Mahon, in Cork, where there was a lot of resistance from the VHI to covering that. There may be very good reasons for it, but I am still at a loss as to understand what those reasons are. Those are the issues I am concerned about. How will we incentivise young people to take out health insurance and how will we generate more competition by health care providers?

Senator Crown will give out to me about this, but in talking to some insurers they mention consultants - not necessarily consultants' pay but how the whole health care system is delivered. There needs to be streamlining and more efficiencies must be brought to bear on that. What suggestions or recommendations do the insurers have in that respect?

Were insurers invited to make submissions to the commission on universal health insurance? Why was there no insurers' representative on the commission? In advance of the commission being established, did insurers make their views known that they wanted to have a representative on it?