James Reilly (Dublin North, Fine Gael) | Oireachtas source

I agree with Deputy Billy Kelleher in the sentiments he expressed. Young people are not being discouraged from entering the market. I hope the Deputy joins me in calling on insurers to provide student cover until the age of 23 years, as provided for in legislation. The insurers can do so if they want, but they have chosen not to do so. They are free to offer products and set prices at whatever level they like, subject only to compliance with certain minimum benefits outlined in regulations made under the Health Insurance Acts. My role is to ensure individuals who choose to purchase such products are protected from discrimination.

Deputy Denis Naughten made an interesting point about smoking. We want to see the Bill passed as quickly as possible because it will have an impact on the market early in the new year. However, we will refine and re-examine it as we go along and I can see a way by which we can take on board the concerns of the Deputy such that a smoker can be loaded as long as he or she is not penalised because of his or her age. The loading should be the same for smokers of all ages because we believe in community rating and do not want a difference to emerge, as that would make obesity, for example, more difficult to deal with. The issue of cigarette smoking could be examined and I will be happy to do so. There will be ample opportunity to revisit the matter because the matter will come before the Dáil on an annual basis.

The best way to ensure health insurance will be affordable for everyone is to reduce costs. This must be done. I have issued clear riding instructions to the new CEO and chairman of VHI that I expect to see the costs issue tackled. I expect to see a more robust audit and, for the first time, there will be a clinical audit in order that clinicians will be challenged on whether the carrying out of tests was necessary. Fines will ensue.

We can also cease paying by the day and pay by procedure. Private and public hospitals that are efficient in getting in patients on the day of a procedure and home quickly, with low readmission rates, will thrive. I also want to have a full examination of what we are paying for all procedures. Certain procedures used to take two hours but now take 20 minutes. However, we still pay the same remuneration rates. This issue must be addressed.

One of the main purposes of the Bill is to enhance intergenerational solidarity and solidarity between the healthy and the less healthy. This is reflected in my amendment to the Bill which broadens the scope of the cost subsidy to include more of the healthy, generally the young, and the less healthy who are generally older. Another issue we are discussing is that of lifetime community rating which could be introduced to allow insurers to charge people over the age of 30 years taking out health insurance for the first time a loading based on the age at which they take out private health insurance. These are issues I am happy to examine and take suggestions on, but, in the interests of getting the Bill through as expeditiously as possible, I will not accept the amendment. As Deputy Billy Kelleher pointed out, he expected this to be the case. I thank him for raising the issue because it is an important one. We are examining different ways to make health insurance more attractive and affordable for younger people.

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