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

I will reserve criticism regarding the documentation for another time. I am not saying it is the Minister's fault but this committee should have had at least some documentation in advance to prepare for this discussion on the Estimates for 2013. I am disappointed about that.

The European Observatory on Health Systems and Policies report is quite extensive and it makes for interesting and, at times, depressing reading in view of the challenges with which the Minister, the Department and the HSE will be faced in dealing with demographic changes, population increases and the profiling of our population and the difficulties and challenges that will raise. On the issue of primary care and free GP care, the authors of that report warn that the efficiencies gained from planned and additional reforms will not be sufficient to fund the Minister's ambitious plans to provide universal access to primary care and strengthen services. The reports states that these commitments will require additional revenue. It also states that although there is scope to make substantial additional savings through greater efficiencies, these cannot be made within the required timeframe without damaging patient care unless high salaries and the high price of other inputs are seriously addressed.

In terms of the Minister's commitment to provide free GP care and moving to provide it in 2013 to those on the long-term illness scheme, the fact that the report also states that we have the highest GP costs in the OECD, and given that the Government has not entered into discussions on the contractual changes that will be required to move to a system of free GP care for everybody, how far down the road has the Minister gone or does he envisage he will get involved in discussions with GPs on this? If we move to the provision of universal primary free GP care and if GPs charge people €55 a visit, my concern is that the Minister will bring in a very expensive system into universality. I am concerned that would involve a great deal of pressure for people.

We saw the difficulties that arose regarding the policy on the medical card for those over 70 when the Minister was on the other side of the fence with the IMO. Effectively, the then Government announced a policy decision and it then had to negotiate with the doctors who are solely contracted and they had quite a strong argument to make in terms of what they charge for provision or those over 70. If we have the dearest GPs in the OECD, I am concerned that this expensive system, which is currently paid for by people when they visit the GP, will be brought into universality. What has the Minister put in place to address that issue? We all accept that if we get universality in terms of access at primary care level that would be a good development but my major concern is the expense given that nothing is being done currently or was done previously to drive down the cost of GP visits, the cost of which is €55 a visit - the average cost being €51 according to the report. The average cost of such a visit in France is €22. Clearly, the cost here is a major difficulty.

The report deals with the Minister bringing in his reform proposals, the cost of the provision of care and points to salaries, particularly consultants' salaries. It acknowledges there is a reduction in this respect of 30% in the case of new entrants but that no other advances had been made in that area. Those are two points. We have only three minutes to speak on this.