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

I accept what the Chairman and Deputy Naughten said in terms of the sentiment. What we have to do is create a situation where both the patient and the insurer are incentivised to keep out of hospitals. The risk equalisation scheme is attempting to do that. As I said at the outset, we do not have enough information yet. The Dutch use this system but they have nine different parameters to use in this regard.

We are trying to increase the factors to be risk adjusted to include a measure of health status and, where available, pharmaceutical cost groups or diagnostic cost groups are used internationally as an indicator of chronic illness and attract risk equalisation payments accordingly. They have been very successful in Holland in doing this. While those data are not currently available in Ireland to the level of detail required, I am committed to developing proposals to risk adjust based on a measure of chronic illness when the necessary data are to hand. It is an area in which I consider the market operators can be of particular assistance. Once the required data are gathered, I intend to progress work on developing a usable risk adjustment measure for health status.

In the meantime, this Bill provides for resource usage to be used as a proxy for health status as a risk factor. Resource usage data are readily available and easy to verify and are used in other countries to risk adjust but this will put it up to the insurers. We want to engage with them and we are putting it up to them to come up with some ideas as the operators in the market as to how we can help them insure people are treated at the lowest level of complexity that is safe, timely, efficient and as near to home as possible, which I think is something everybody here agrees with. I do not see any problem with a sunset clause and I will certainly look at that for Report Stage.