James Reilly (Dublin North, Fine Gael) | Oireachtas source

I commend the Deputy on his research. He has good facts about issues that need to be considered.

The role of the clinical programmes in public hospitals has caught the eye of the VHI. I have asked Dr. Barry White to engage with the VHI in this regard. I have also asked Dr. Martin Connor to engage with it in terms of what we have been doing in the public sector that might inform it. For example, paying per procedure instead of per day, which the public sector has started doing, will be informative for the private sector.

I agree with the Deputy regarding the HIA. We must examine its role in the matter he has raised and beyond. It needs to be beefed up considerably because it will be responsible for ensuring that there will be no cherry-picking in the new system that we intend to create. This will be quite a job and I imagine that the HIA will need to be given additional enforcement powers. Underpinning the success in Holland is a strong insurance regulator, one that really regulates. We will not go over the history of regulation in this country.

One of the aspects that would concern me, and it relates to the Deputy's concern, is that there are over 5,000 different policies. That is designed to confuse. The purists will argue that when all of that is stripped away there are only about 200 different policies but there are too many policies. The Health Insurance Authority must be empowered to regulate that and bring it down to a manageable number of different products that people can understand to ensure they do not get confused. It must be the seed of confusion to have that many different policies; one would be mind-boggled by the time one finished.

The Deputy is right. People are slow to change, and older people are slower than others to change. The old adages still apply. People do not like change. They trust what has been with them for 30 or 40 years and they do not like to have to look around elsewhere. There is no question that there have been changes in some of the policies which have mitigated against older people when they start taking hip procedures or ophthalmic surgery off a plan that people have used historically. That is designed to discourage older people from the plan and make it more attractive to younger people. We must guard against that. I hear what the Deputy is saying, and I will take up the caesarean section issue with the special delivery unit. The Health Information and Quality Authority, HIQA, needs to be informed about that also because it is disconcerting to see such a difference between several of the issues the Deputy has raised and the rationale behind them.

That brings me to the other point. I have asked the Voluntary Health Insurance, VHI, to discount heavily against any doctor, consultant or general practitioner who carries out procedures in hospitals that should be carried out in primary care and end up attracting a big side-room fee.