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

As I have stated on a number of occasions, it is unacceptable that the cost of private health insurance continues to increase. It is also unacceptable that the number of health insurance claims increased by 14% in 2012, given that the number of people insured declined last year. There is no proper audit of the sector. For example, there is no clinical audit, in other words, treating physicians are not challenged to explain the reason procedures have been carried out. This is a major gap, one that I have insisted VHI, as the largest insurance provider, address. The company may have only 57% of the market, but it is responsible for 80% of the money paid out on claims.

Another issue that must be addressed is the practice of paying the same amount for procedures that may have attracted a large fee previously because they took two hours to complete but now take 20 minutes as a result of advances in technology. Health insurers must also shift from paying per diem charges to paying per procedure. I have raised this issue in my Department as it would allow those hospitals that are efficient, perform day procedures and have reduced numbers of readmissions to thrive. I have informed the joint committee previously of a case in which I was approached by a man whose MRI scans had cost VHI more than €6,000. He travelled from the country to Dublin on a Sunday to have an MRI scan done on the Monday, only to be told that it would be postponed until the following Wednesday because of an emergency. He was told not to go home and remained in hospital throughout. Such farcical practices must stop. Much work remains to be done and I am not satisfied that progress is being made quickly enough. I have had numerous meetings with VHI and I am putting the company under the cosh. The Department will engage in further actions to address VHI's costs in the near future.

The Minister of State, Deputy Alex White, will address the issues raised concerning dentistry, while the Minister of State, Deputy Kathleen Lynch, will address mental health services and cochlear implants. I assure members that the budget for next year includes funding to enable Beaumont Hospital to do work on cochlear implants. The hospital must perform a balancing act. First, it must catch up in respect of those who received single cochlear implants and thereafter must commence a double implant service. It is obviously cheaper to do two implants at once.

The position on non-consultant hospital doctors, NCHDs, in Drogheda and Letterkenny will be addressed through hospital groups. Once these are established, NCHDs will be employed by hospital groups as opposed to individual hospitals. Mr. Barry O'Brien will provide some more detail on this issue.

The issue of publishing service level agreements is one for the Health Service Executive. While the agreements are large, I do not see any reason they should not be published, as they are a matter of public record.

Deputy Seamus Healy asked about having specialist representation on the boards of hospitals. I presume he is not referring to medical specialists. While the boards will have some clinical input, no members of staff will appointed to boards. This is in line with a recommendation issued by the Health Information and Quality Authority as part of its investigation into practices at Tallaght Hospital. We want people who have specific capabilities or competencies to be on the boards of hospitals. These include competence in accountancy, human resources, the financial and legal fields and information technology. We also want to ensure the regions are represented.