Jan O'Sullivan (Limerick East, Labour)

In any case, the point I am making is that at some stage we will have to say that the current system does not work. I would like the Minister to comment on the consultants' contract and public-only consultants because they are measures she introduced. I welcome many elements of what she is doing but would it make more sense to have a one-tier system where everybody is treated fairly whether that be through multiple insurers or a social insurance fund?

Much of the division of the system was meant to be based on co-located hospitals and many elements of the consultants' contract were designed to facilitate the co-location system; private patients would be admitted to the private hospital and public patients would be admitted by public-only consultants to the public hospital. The Labour Party abhors this because it is apartheid in health. It appears that those co-located hospitals will not go ahead - and I hope they will not - and that we will have a system with different types of consultants operating in the same hospital with different rules for different types of patients. The entire system is very confused. Will the Minister comment on whether she thinks fewer people will take out private health insurance? Will fewer people be able to afford it?

Will the Minister explain further what she stated in her speech on reviewing the minimum level of benefits? It is important that we know what exactly she means by that. Will it have an implication on the cost of private health insurance? I do not know whether the Minister will review it up, down or sideways.

Deputy Reilly referred to the significant increases in costs that occurred around the time the legislation was published at the end of 2008, particularly for the VHI. It has meant that many people cannot afford private health insurance.

The Minister also said she intends to ensure that the full cost of private patients in public beds is repaid and that the rules providing that in public hospitals 20% of beds are for private patients and 80% for public patients will be implemented through the clinical directors. That is the right thing to do. Private patients in beds they should not occupy should not be subsidised by the public system. However, the fact that 55% of the population has private health insurance suggests that this will be difficult. Many questions regarding the issue of health insurance that will arise in the next few years will affect the cost of insurance for members of the public and ultimately will change how the money available in the system is spent.

Another issue is the mechanism and the concerns of smaller insurers. One of the concerns is that the levy is unfair because it is applied across the board. Colin Morgan of Quinn Healthcare stated in an article in the Sunday Business Post:

Our main concern relates to the €160 levy per member. This levy is due per member irrespective of the level of cover a member has (ie a 50 per cent levy on lower plans and only 8 per cent on high level plans). This ultimately means that less well-off people on lower plans are subsidising those better off who can afford premium plans. This is totally unfair.

It appears to be unfair to impose this levy across the system, irrespective of the plan a person has. I share Deputy Reilly's concerns about students. The Minister said she will propose amendments to the legislation so perhaps she would indicate if she will address these issues in those amendments.

The Minister referred to other schemes and said it will not cover the smaller, controlled schemes for specific people. She mentioned the schemes for the Garda, prison officers and ESB employees. How does the Supreme Court decision affect those schemes or does it affect them? Can community rating still be implemented through risk equalisation within those schemes? Perhaps the Minister would clarify that because we must ensure that those schemes are fair to their members. In that context, when the Labour Party proposed its universal health insurance system it envisaged that it would encourage mutual or non-profit insurers to come into the market; for example, the trade union movement could provide an insurance scheme for its members. It would be somewhat similar to the schemes available for certain workers. Ideally, in providing for competition in the market, we would prefer that it would not simply allow private companies to cream off their portion of the money but that it would encourage, in terms of the insurance market and the providers of health care, non-profit organisations for the mutual benefit of the people who subscribe to them.

How would the Minister envisage that working in the context of this legislation and the legislation she is working on for the long term? It is preferable to having a raft of private insurers all trying to make a profit because, unless it is extremely well regulated, there is a danger that it will result in higher costs. The American market is a fine example of that. The health service in the United States is very costly and the private system is not appropriately regulated. Practitioners end up ordering all kinds of unnecessary tests. As it is such a free unregulated market it is very costly, not effective and not inclusive of many members of the American public. Apparently it is about to be reformed by the current President.

See this speech in context