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

I welcome all the delegates. The issue before us has been discussed for some time at this committee, in the Dáil and general public discourse. There is no point in pretending the health insurance industry is not in crisis. Families are being put to the pin of their collar as they try to retain private health insurance. I have opposed, sometimes as a lonely voice, certain Government policies on health insurance, including imposing a full cost charge for private patients in public beds. This and other policies are escalating the price of health insurance.

As the dominant player in the market and the company which sets the trends and impacts on the other health insurers and broader health insurance market, I will first put questions to VHI. The Milliman review of VHI was not especially complimentary. It noted, for example, inefficiencies in administration and other areas where VHI's cost base needs to be reduced. I find disturbing the charges the health providers levy on health insurance companies. The average length of stay for procedures is also a concern, particularly given advances in technology and medicine. Surely average stays should be diminishing rapidly, but this does not appear to be the case. I refer to a highly disturbing, if isolated case, which raises a fundamental issue. It was highlighted in a report by Susan Mitchell in the Sunday Business Post of 17 February. She noted that in the case of one Dublin man who had spent the night in a private hospital in Dublin for a procedure on his eye, VHI had paid more than €4,300 for the hospital charge which did not include pathology test fees or the payment to the surgeon. These were detailed separately and amounted to an additional €1,400 on the bill seen by the newspaper. I have no reason to question the integrity of the eminent journalist in question and assume, therefore, that her report is factual. Moreover, I understand the report was not contradicted by VHI.

I have doubts about the proposal to move to a universal health insurance model, although it appears to be supported by most of the delegates. If we are to do so, VHI and the Minister for Health should be trying to create a dynamic health insurance market that is competitive, robust and expanding, as opposed to contracting. If we are to move from a position in which the number of people with private health cover is declining and adopt a universal health insurance model, a large gap must be closed. This can only be done in one of two ways, either by direct subvention by taxpayers for individuals who will have to take out universal health insurance or a massive increase in premium cover rates. VHI has a major obligation to try to reduce costs, as does the Minister, given that the State is a major shareholder in the company.

If memory serves, VHI has a workforce of approximately 900, a significant number of people. Administration costs must be reduced and the company must also try to force down the charges levied by health providers. It does not appear to take a robust or aggressive approach to driving down costs. I am sure Mr. Dwyer will have a different view on the matter, but there appears to be some evidence to support my view, including the findings of the Milliman review and others that have observed VHI's interaction with health providers.

On the full cost charge for private patients in public beds, most people are entitled to universal health care by virtue of their citizenship and status as taxpayers. If we continue to charge the full cost of private beds in public hospitals, we will further drive up the cost of private health care.

We are going to force more people out of the market, as is evident, and more people into the public hospital system. It is straightforward arithmetic. We are heading into it without observing the impact it will have in the short and medium term in the rush to seek the Holy Grail of universal health insurance. I do not believe the policymakers, the Minister and the Department have examined the issue in detail to see the crippling impact it will have on people who are already struggling and trying to fund private health insurance, which is a noble aspiration in the sense that they want to remove the burden on the State in providing their health care. They are willing to pay for themselves and they are utterly overwhelmed by the increased charges that are a direct result of policy decisions, not marketplace decisions, in terms of charging private patients in public beds. Clearly, that is an issue that has to be revisited very soon.

With regard to the advanced and the non-advanced policies, I had assumed there were 47 policies that had been pointed out as being non-advanced. When we debated the issue in the House, it was highlighted as part of the legislation that non-advanced policies would not attract the higher levy rate. We now find there is no non-advanced plan in the State. Were the insurers pretending they were selling non-advanced plans all along, or was there a policy change at some stage between the legislation being published and the legislation being passed? This is critical. This is about fairness and supporting people who are at the threshold of having to let go of private health insurance because they cannot afford it. This policy change will have a direct impact on people's ability to take out and retain private health insurance.

Mr. Dónal Clancy mentioned that there are no non-advanced plans available and there will have to be a redesignation at some stage and new plans put in place. Is he saying that would subsidise the hotel-type plans?