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

I welcome Dr. Turner. I declared to the committee last week that we commissioned Dr. Turner to independently evaluate universal health insurance as proposed by the previous Government and other funding models. That was independent, as opposed to Fianna Fáil policy. I wish to be very clear on that.

There are a few issues that have been consistently raised. There are also the ideological debates on the funding of health care and access to health care, but I wish to get back to the pragmatics of it. Dr. Turner said that we have a very intertwined public health system and private health system in this country due to the fact that many beds are used on a daily basis to treat private patients in public hospitals. If we are trying to get to a single-tier universal health care model, how would Dr. Turner propose to disentangle that dichotomy of private patients in public hospitals? Is there capacity enough in the private system for private patients to be treated there? In very complex cases in which the private system simply cannot treat the complexities of individuals, what sort of funding model could be put in place to ensure that the public health system is fully reimbursed?

There is the other issue of the disparity in access for diagnostics and treatment between public and private, which is always pointed out and rightly so. How could it be possible to have a single list of people in both public and private who are trying to access public hospitals, if the witness understands my meaning?

When we talk about health care and the public health system and say that the private system should be reduced or not depended on, we must remember that the vast majority of primary care is delivered through the private sector in terms of GPs. By and large, they are sole traders and operate independently, subject to the contract itself. Where does Dr. Turner see the role of GPs and the broader primary care system in the delivery of a universal primary care system? Does he see a need to expand salaried GPs? How would the witness bring that to a situation in which there would be an obligation on GPs to deliver a fully-funded universal primary care system?

How does the witness see the issue of tax relief for private health insurance? A view is sometimes put forward that people who retain private health insurance are somehow queue-jumping elitists. Of course, half of the population have private health care. They are subsidised to a certain extent by the fact that they get tax relief for their private health insurance. The quid pro quois that they are equally subsidising the State by the fact that they do not depend on the public health system for their health care. In the event of there being a universal health care system, then they would be dependent or could call on the State to ensure that it would provide health care for them. This is an area in which affordability is going to be a key issue. We cannot dismiss this as a committee if we are to move towards expanding the public health system to deliver a universal single-tier health system.

The witness spoke about additional GP numbers of 2,900 and additional beds of 9,000. While it is aspirational, how affordable would it be to expand capacity out in the short, medium or longer term? It would be a folly not to at least use the capacity of the private health care providers in the short and medium term to expand the capacity of the public health system. There is the National Treatment Purchase Fund, which I accept is a short and medium-term solution to overcrowding and waiting lists.

With regard to the recruitment of consultants and consultants' contracts, there seems to be a huge issue with incentivisation, where consultants are more incentivised to treat patients in the private health system rather than the public health system. How does Dr. Turner see that issue being addressed if we are to disentangle the whole concept of public and private?