Denis Naughten (Roscommon-South Leitrim, Independent) | Oireachtas source

I want to speak on this issue, although we have had this discussion before. I disagree with the use of this as an indication of health status. The hospital bed utilisation credit is the wrong way to go in regard to defining health status. When the legislation was introduced 12 months ago and this new definition, the hospital bed utilisation credit, was introduced into the health insurance system, we had this debate. The Minister has explained the basis for the credit and I understand that. The difficulty is that now, 12 months down the road, we are still using the same tool to measure health status. This encourages health insurers to send clients through the hospital system, which is contrary to the direction we should be taking. We should be encouraging insurers to ensure people are treated outside of the hospital system.

The Minister will argue that this is a relatively small payment that is only indicative of the utilisation of health services in general, but the ethos and thrust behind the development of our health service and everything the Minister has espoused is to try to encourage insurers to ensure people are treated as close as possible to home and in the primary care setting where possible. This is part of our objective of universal health insurance. This bed utilisation credit system builds in an incentive for people to be treated within the hospital setting.

I know the Minister will make the financial argument that the cost of a hospital bed is €600 or €700 a day and that the insurer is only getting a return of €60. However, the problem is the ethos created in regard to this. The Minister's accounting mechanism in regard to insurance acknowledges someone's occupation of a hospital bed as a calculation in regard to health status. We should be doing the opposite. We should be rewarding insurers that keep people out of hospital and that, through proactive schemes, ensure they do not go into hospital. We should have a far more effective mechanism of measuring health status than hospital bed utilisation. I cannot see how, 12 months after the introduction of this measure, we have not developed this. All we are doing is tweaking and tinkering with hospital bed utilisation rather than coming up with a more accurate assessment. As the Minister said, the legislation we are dealing with now is putting risk equalisation on a permanent basis. As a result, it is also putting the measure of hospital bed utilisation on a permanent basis, instead of coming up with a more effective way of measuring health status.