Brian Cowen (Laois-Offaly, Fianna Fail)

The HSE has been doing much good work to make sure that money follows the patient and that resource allocation is appropriate for the needs of patients. The issue referred to by the Deputy relates to a position he outlined in recent times. We have invited him to get his plan objectively costed by the Department of Finance, but so far he has declined to do so.

Two key changes would probably be involved in the Deputy's proposal. There are differences between the organisation of the private medical insurance systems in Ireland and the Netherlands. I understand that there are approximately 17 private health insurance companies in the Netherlands, with no company having more than a 25% share of the market. There are three or four such companies in this country, with the VHI having almost 70% of the market. One of the problems with the proposal is that it might lead to private insurance companies making decisions on all hospital and GP services. They might decide which hospitals carry out which services.

There are 14 health insurance companies, as well as related subsidiaries, in the Netherlands. That is not the case here. It has also been proposed that health insurance should be compulsory. Some people who do not currently buy health insurance would be required to do so. It is obvious that not everyone gets health insurance for free. It has not been made clear who will have to pay more, and how much more they will have to pay. The proposal involves new public spending. We do not agree with the claim that the State can subsidise the entire cost of new private health insurance policies for approximately 1.3 million people with medical cards, as well as heavily subsidising the cost of including 660,000 more people in the scheme, at no cost to the Exchequer because it is not feasible. Perhaps the best means of starting a debate on future health reforms would be to get the Department of Finance to cost them in the first instance.

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