Mary Harney (Dublin Mid West, Progressive Democrats)

On the supply of private facilities or consultants, in most insurance markets companies like to see more suppliers of products and services because this drives innovation and drives down prices. The health insurance industry in Ireland is unique, perhaps because there has mainly been one company, apart from the providers of the ESB and Garda medical schemes, offering insurance in the market since 1957. The view was taken that the fewer the number of private hospitals, the better, but neither I nor patients accept this. Deputy Twomey knows as well as I do that the huge shortages are such that many patients must wait some considerable time for access to a consultant. The private system has not filled the gap, as it would do in other countries.

We need 1,500 more consultants so everybody can gain access to one quickly. If somebody tried to suggest to me that we should limit the stock of private hospitals to keep down the price of medical insurance, I would reply that it would also delay patients' treatment. This is not a solution to any problem.

Collocation has been proposed for a very good reason. The beds involved are ring-fenced for private patients in public hospitals and are funded and staffed by the taxpayer. Everybody should have access to these beds. Equity of access is central to our new contract of employment for consultants. Access to facilities funded by the taxpayer should be on the basis of equity and one group of patients should not be privileged over another. This is why nine hospitals are so interested in collocation.

Collocation provides an on-the-site response. The taxpayer obtains money from the lease or sale of the land in question rather than having it used as a carpark. The public system can procure, if it wishes, services from the private provider, or the private provider can procure services from the public provider. Thus, both sides work in a co-ordinated way, as is the case at St. Vincent's Hospital. This system is preferable to having one in which a plethora of small private hospitals emerge, which are not connected to the public hospital system. If the two are connected, a better service is afforded to patients and we get better bang for our buck.

Community rating and competition are fundamental to my policy and that of the Government. If there is no competition, there can be no innovation or good value. Rather, there would just be a monopoly supplier of services in the market. Obviously there cannot be community rating without risk equalisation because, if one company has all the younger premium holders and another has all the older ones, they could not compete on a level playing field.

I recently met a couple in their 60s who returned to Ireland after having lived in the United Kingdom. They stated that, because of their health condition, their insurance in the United Kingdom cost £12,000. Their health insurance in Ireland, involving one of the better plans, costs in the region of €2,200. That shows the difference. There is no doubt that, without community rating, insurance cover in Ireland would be held by approximately 10% to 12% of the population and certainly not the 54% who hold it at present. Community rating is central to Government policy.

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