Jan O'Sullivan (Limerick East, Labour)

Perhaps the Minister can clarify it at the end. However, if she could give us a clear declaration, which has been called for by both of us who have spoken, that the levy will be used within the health insurance market, it would go some way towards providing assurances in that regard.

I want to refer to the number of people who have private health insurance, which is 52% at present. We are going through a process of economic change and with people finding it harder and harder to afford private health insurance it is inevitable that some will drop it because they will not have the money to pay for it. I welcome the fact that with the new consultants' contract we have public-only consultants. Last week, the Committee of Public Accounts heard that there is a difficulty with the estimated €50 million whereby these public consultants admit patients with private health insurance but there is no mechanism for charging that money to the private health insurers. I would welcome the Minister's comments on that because it is an issue of concern to the public purse.

The Minister also told us, in the context of the consultants' contract, that there will be a one-tier waiting list for certain procedures, including diagnostics and colonoscopies. I welcome this very much because the Labour Party wants a one-tier system for everybody. Will this mean that fewer people will feel the need to have private health insurance? There is always the dilemma that if one makes the public system better - and we must make the public system better - people will wonder why they have private health insurance.

We have a messy hybrid system with all sorts of perverse incentives; in primary care one is incentivised not to go to the doctor because one must pay if one does not have a medical card and in the hospital system the incentives are the opposite. It is such a mixed system that it is a mess in comparison to most other countries which have straightforward systems, whether it be the NHS in Britain, the system in Holland that is the preferred option for Fine Gael, or systems of social health insurance in countries such as France or Canada. I know there is a mix of public and private in all countries but we seem to have the most messy mix of any country.

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