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

Nobody likes to hear the truth, but as an old lady once said to me "The truth is not fragile, doctor, it won't break." The truth is that the Government of which Deputy Kelleher was part had the power for 14 years and did nothing to address this issue. I wish to correct the record of the House because all sorts of outlandish claims have been made from the far side on increases in insurance. In 2009, health insurance increased by 11%; in 2010 it increased by 7%; in 2011 it increased by 10%; and last year it increased by 12.1%. The trend started in 2008 and for more than three of those years the Fianna Fáil-led Government had responsibility for it. It sold our financial sovereignty and left us with the biggest debt the country has ever seen, and Deputy Kelleher wonders why some of the costs of living have to increase. His vision of reality is quite remarkable.

There are a number of other important stepping-stones to achieving the goal of universal health insurance. Good progress is under way in the strengthening of primary care services to deliver universal primary care, as well as ongoing work in tackling waiting times and establishing hospital groups. When I came into government I set up a special delivery unit, SDU, in my Department. The SDU started a major national programme aimed at helping hospitals to tackle the problems associated with delays in accessing care. Hospitals were set ambitious targets and in the main they met them. Through meeting them, clinicians adopted new ways of working.

During 2012 there have been significant improvements in hospital access targets, including a reduction of 23.6% in the number of patients waiting on trolleys in 2012 compared with 2011, which equates to 20,352 fewer patients waiting on trolleys. There are still too many people waiting on trolleys, but already in the first two months of this year we have seen a further reduction of 10% on 2012. I remind the Deputy - his memory seems to fail him sometimes - that the month before the general election that saw the removal of his Government had the highest number of patients on trolleys since records began with 569.

On scheduled care we set a nine-month target and the number of adults - excluding endoscopy - having to wait more than nine months for inpatient and day-case surgery was down to 86 at the end of December 2012, from 3,706 in December 2011, which is a 98% decrease. The target for 2013 is a maximum wait-time guarantee of eight months. In the paediatric area we set a 20-week access target and the number of children - excluding endoscopy - waiting over 20 weeks was down to 89 at the end of December 2012, from 1,759 in December 2011, which is a 95% decrease. The number of patients waiting over 13 weeks for a routine GI endoscopy procedure reduced from 4,590 in December 2011 to 36 at the end of December 2012 representing a 99% decrease.

All this was achieved despite having to remove more than €3 billion from the health budget in recent years and despite several thousand people - most of them in February 2012 - leaving the health service. We are trying very hard to ensure that by 30 November 2013 no patient will be waiting more than 52 weeks for a first-time consultant-led appointment. I heard Deputy Kelleher say that he would cover more of this in his wrap-up speech tomorrow night. Perhaps he would be good enough to tell us why, despite all its years in power, Fianna Fáil never even bothered to count the number of people waiting on an outpatient waiting list. This is the first Government to do so and we are not afraid to admit there is a problem and to say we will address it. We have said we do not want any patient waiting longer than 52 weeks for a first-time consultant-led appointment by the end of this year. That is a very ambitious target and we will seek to meet it.

On access to GPs more than 1.8 million medical cards - the highest number in the history of the State - have been issued to individuals. That is the highest in percentage and absolute terms. The Bill to allow for the extension of free GP care to persons with prescribed illness will be published this year. I am the first to acknowledge that we have been delayed in that regard, through a combination of very serious technical issues and the volume of legislation to go through the Oireachtas. Progress continues to be made in building primary care capacity and in chronic disease management particularly for the management of diabetes. Funding has been approved for the appointment of 17 clinical nurse specialists whose role will include supporting health-care professionals involved in the provision of care to their diabetes patients in both the primary and secondary-care settings.

In moving towards universal health insurance, community rating is a fundamental cornerstone of the Irish health insurance market. This means that the price of health insurance for all persons should reflect the principle of intergenerational solidarity, that is, that the entire community of privately insured persons should contribute towards the higher costs of claims for older people and less healthy people. Under community rating, everyone is charged the same premium for a particular health insurance plan, irrespective of age, gender and the current or likely future state of his or her health. Community rating therefore means that the level of risk a particular consumer poses to an insurer does not directly affect the premium paid. I know the Deputies on the far side of the House agree with that principle.

The pricing of risk across the community of insured persons clearly requires robust mechanisms to share costs when there are several insurance companies in the market. The standard transfer mechanism to support community rating is called risk equalisation. The aim of risk equalisation is to look at the market as a whole and distribute fairly some of the differences that arise in insurers' costs due to the differing health conditions of all their customers. Community-rated health insurance systems across the world use this as a means of providing the necessary support for the market.

An effective risk equalisation scheme creates an incentive for insurers to focus on innovation, greater efficiencies and improved customer service rather than on selecting customers based on risk. This is the type of competition that is best for consumers. In this context, I am pleased to note that two major reinsurers are now involved in providing underwriting services in the Irish market. In the lead up to the introduction of universal health insurance it is critical that private health insurance remains affordable and that the market is competitive.

See this speech in context