Denis Naughten (Roscommon-South Leitrim, Independent) | Oireachtas source

First of all, I have a few questions for Mr. John O'Dwyer of the VHI. The first one concerns the whole solvency of the VHI. What is the deficit and what will the taxpayer have to put in to meet that shortfall? Has the deficit increased or reduced over the last couple of years?

Has the Milliman report, on the operation of the VHI, been implemented in full? If not, what aspects of it have not been implemented? That particular report flagged inefficiencies concerning the claims system, so have they now been addressed? Is the VHI as efficient as it can be concerning claims?

Senator Crown made the point that under a UHI system people will be able to go to any hospital they like. Mr. O'Dwyer was involved in the Dutch insurance industry, so is it the case in Holland that all insurers cover people to access all the hospitals or do they have a situation like ours?

We see in today’s newspapers that one will have to ring up one’s insurer to see if it will provide cover in a particular hospital for a particular procedure. There have been numerous problems where people have not been covered after getting treatment and, subsequently, faced significant bills. There is the example of a hospital in Mahon, Cork, not being covered. There is a concern that under universal health insurance, UHI, insurers may not cover all hospitals, particularly the smaller hospitals like my own in Roscommon which does not have an accident and emergency department. Such a move will undermine the viability of the hospitals affected and cause them reputational damage. It will also reduce choice for patients in smaller population pockets and not allow them access to local hospitals. Under UHI, will the insurers cover all hospitals? Are there circumstances at the moment where the insurers would not cover all hospitals? That would have a significant impact in public hospitals if there were such a move in that direction.

Up to 200 people a day are ending their health insurance, mainly younger people. What can be done to keep them in the market? What can be done to drive down costs of treatment? Yesterday morning, I, along with Senators John Crown and Colm Burke, attended a briefing from the Economist Intelligence Unit at which it pointed out that 40% of the EU population over the age of 15 has a chronic disease. The long-term treatment of such chronic diseases has a significant impact on the overall cost of health insurance for society as a whole. What can be done to deal with this?

Senator John Crown asked earlier why a smoker should pay the same insurance premium as a non-smoker under the UHI model. However, under risk equalisation, why should someone involved in a risky habit get the same level of cover for the same price as someone who is scraping to make ends meet? The regulator stated claims are driving up premiums. The Voluntary Health Insurance, VHI, report stated claims have gone up by 15%. Yet, insurance premiums have gone up significantly more than that. More important, the total value of claims has gone down by 5.6%, mainly due to driving down consultants’ fees. Maybe the VHI should be negotiating with them rather than the Department of Health. What savings can be made in the public hospitals system, as that seems to be a fixed cost?