Michelle Mulherin (Mayo, Fine Gael) | Oireachtas source

I welcome the opportunity to speak on the motion. Health insurance is a vicious circle as the more people who leave it, the more expensive it becomes and then more people leave it. It is an issue for lower income families, not least on account of the fact that those on higher incomes get tax breaks on their health insurance premium. The measure of the cost of cover, perhaps €3,000 or €4,000 for a family, is not based on one's income but on risk. Any steps which can be taken for those who genuinely want health insurance but find it is outside their grasp should be pursued. We must also recognise the tax break is not as attractive or significant for lower income families.

I very much welcome the concept being pursued by the Minister of money following the patient. It makes sense that hospitals and health services are paid on the basis of the service they provide and are not blindly given a block grant, the details of which can lead to inefficiencies. I welcome the development of a more efficient system as we move towards universal health care, which will be very much welcome.

Sometimes we forget the onus is on health insurance companies to challenge the costs charged by hospitals and consultants, and in doing so reduce the cost of health cover. In some cases insurance companies are handed a bill and very little checking is done to see what they get for their money. They simply pay. They have a role to play in demanding efficiencies in hospitals, including the use of step-down beds. We must think outside the box. Perhaps a patient having a day procedure but who needs to be seen the following morning could be put into a hotel at a much lower rate, depending on medical requirements. We must examine the costs and be creative in how they are reduced. At all times we should look towards reducing costs and making health care and health insurance affordable.

While I have the opportunity to do so, I wish to raise briefly the problems being encountered with the fair deal scheme, whereby older persons experience inordinate and excessive delays in having their applications processed. Not only does this mean they remain in local community hospitals where they take up what should be step-down beds, but in some cases they are in acute hospital beds, which means other patients are on trolleys. Money is being put towards caring for the elderly in long-term residential care, with approximately €1 billion being invested last year and more than 22,500 people being provided for through schemes such as fair deal and subvention. None the less this problem prevails and is a real issue for hospitals which experience blockages. People cannot leave hospital because they cannot get approval under the fair deal scheme. I am not sure how it can be addressed because properties secured after someone's death cannot be sold. The question is what is the market value of a property which cannot be sold. There inherent problems are caused by the economy and the property market. With regard to efficiencies and expensive hospital beds being taken up, something must be done to allow the more rapid processing of fair deal scheme applications.

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