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

Deputy Naughten's amendment aims to encourage people to stay or become involved in health insurance and make sure they will go into universal health insurance. The key point there is that universal health insurance will be mandatory so there is no need for incentives to get people into universal health insurance. It will be the law and we have a mandate from the people to do that. It is in our programme for Government and our electoral programme.

The White Paper on universal health insurance, which will be published next year as opposed to the paper which is coming out in a couple of weeks, will outline the details of the universal health insurance model in addition to the estimated costs and financing mechanisms associated with the introduction of universal health insurance. There are many key decisions that require careful planning and sequencing over the coming years and primary legislation, which will be required to underpin universal health insurance, will be developed in the future as part of that process.

The health insurance (risk equalisation) Bill provides for the introduction of a permanent scheme of risk equalisation. Therefore, I do not consider it appropriate to insert an amendment in the current Bill which would have the effect of compelling me to introduce lifetime community rating. However, as I have said, I am disposed to consider any measures that may assist with ensuring the maintenance of a healthy and functioning private health insurance market and will request my officials to further consider the implications of introducing lifetime community rating at this time under the existing health insurance legislation as part of the measures to ensure the sustainability of the private health insurance market in the transition to a universal health insurance system.

I am aware of the concerns of the Deputies and consumers alike about the cost of health insurance and I have outlined some of the areas which I want to tackle next. In fairness to the VHI, I must advise the House that last week, the VHI reported that its cost containment programme has delivered savings of €200 million since 2009 by applying various cost containment measures including reducing consultants' fees by 15% and reducing the prices paid for various procedures by between 13% and 53%. For example, the professional fee for the insertion of an ordinary stent has gone down from €1,100 to €200 and the cost of an MRI scan has been reduced from €650 to €160. However, I have informed the committee that I came across a patient for whom an MRI scan cost €8,000 because he was kept in hospital awaiting it. That is the difficulty of the current situation where we pay by the day instead of per procedure. Paying per procedure would definitely clear out that element.

The VHI has also introduced a payment system for radiologists and pathologists based on the national quality benchmarks which will lead to reduced length of stay and has the potential to save another €42 million for the VHI. It has also focused on claims recovery through the work of its special investigation unit. This is the audit I spoke about - a much more robust audit will be required. The VHI continues to focus on the issues and the findings of an external review of its claims entitled the Millman review.

The challenge for all of us must be to ensure that the health market remains viable and relevant, in particular given its role in supporting the provision of services in the public sector but also as we prepare for the transition to universal health insurance. Our public health sector has led the way in some aspects of this through the activities of the clinical care programmes, which have been far more efficient in recent times. Indeed, the VHI and some of the private hospitals are engaging with the clinical care programmes to make sure that sort of work ethic and protocols are put in place in their own hospitals.

I hope to have the interim paper from the implementation group on universal health insurance by 18 or 19 December 2012. I will not be accepting Deputy Naughten's amendment and I hope he will understand the reason why but I am committed to further examining with my officials the issue of lifetime community rating.

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