Catherine Murphy (Kildare North, Independent) | Oireachtas source

This is a complex and technical Bill. I acknowledge that the Government has no option but to legislate for this issue, but I have mixed feelings about it. It is difficult to see where this legislation fits into the overall scheme of reform of the health service. I would like the Government to provide a road map for these reforms. A universal, single tier system may not be possible within the lifetime of the Government, but there needs to be a time line. We could soon be at a tipping point with regard to the viability of the private health insurance market. Many people - young people, in particular - are ceasing to pay into private health insurance plans. This leaves older people or those with chronic illnesses to absorb most of the costs. Social solidarity is essential if the provisions of the Bill are to be viable.

There is a pecking order in family finances as people prioritise mortgage repayments and heating and food bills. Where there is indebtedness and falling income, health insurance is lower in the pecking order, particularly among the healthy. I am concerned about this.

It is positive that the Bill establishes criteria preventing discrimination against patients by charging them higher premiums on the basis of age, sex or health status. It is important that this be achieved. It requires us to establish a permanent risk equalisation scheme with levies and credits. One can envisage the VHI, for example, attracting a large number of credits because many of its customers are likely to have greater medical needs. This raises the question of whether we will be legally compliant in terms of intervention regarding the fund.

The Health Insurance Authority will have extended powers to establish and administer the risk equalisation fund. Where an insurance company incurs the cost of paying for treatment for a higher-risk patient, it will be able to reclaim some of the cost from the fund. It is in respect of those people who are most likely to end up in hospital that credits will be drawn down. Currently, the system applies only to people over 60. This Bill, when passed, will change this.

The health insurance industry has a for-profit aspect, which implies people will be lobbying for changes. One must be careful to ensure the consumer is the centre of attention rather than the industry, although I accept that the latter must be listened to in a balanced way. One must remember the industry has a motive other than the provision of health insurance cover. One cannot have social solidarity if a sufficient number of people who are not drawing on the fund are not paying into it. People with long-term chronic illnesses or disabilities and the elderly are the most likely to draw on the fund.

When the Minister is wrapping up, I would like him to outline the roadmap and timeline. If a large number of people no longer purchase health insurance cover, we will have to respond quickly. They could opt for cover in a lower category, meaning they will no longer be treated in private hospitals, thereby placing more pressure on certain parts of the public health service. The public system is already under serious pressure. People may remove themselves from the system entirely because they simply cannot pay for premiums. Has the Government determined the tipping point? The decline in the purchase of health insurance cover has gone beyond a trickle and is becoming a steady stream. If we end up with a cascade, when will there be an urgent remedial response thereto? Over the past three years, for example, 175,000 people cancelled their health insurance policies. This has serious implications. There was an overrun in the HSE to the tune of €400 million in September. The legislation is not likely to be cost-free if an additional burden is placed on individuals.

While I accept that there is a need for the Government to legislate, I have mixed feelings on supporting the Bill because we need to know how the system will be handled if we run into the kinds of difficulty it is possible to envisage at this stage. We are good at creating a crisis and then trying to unpick it. This occurred in respect of the centralisation of the medical card system and SUSI. Both crises were predictable. We are not good at putting good institutional architecture in place. The Government has not had sufficient time to deal with some of the issues that have been presented as crises requiring remediation, reform and compliance with the guidelines of EU institutions. Considerable work must be done to achieve reform and to be compliant. With legislation such as this Bill, we realise there is potential for failure. Where this failure could be serious, it is incumbent on the Government, in response to the Second Stage debate, to determine the risks and put in place a strategy to anticipate and respond to imminent problems.

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