John Halligan (Waterford, Independent) | Oireachtas source

The number of people with private health insurance dropped from more than 50% of the population in December 2008 to 45% in December 2012. This decline equates to approximately 200,000 people. New figures from the Health Insurance Authority show that 64,000 adults and children cancelled their cover last year. During the same period the Health Service Executive recorded a 9.1% increase in the number of medical card and GP visit card holders. The promised free general practitioner care for children aged under five years is set to bring another 250,000 young patients into the system at a time when resource allocation to provide this service has been reduced by approximately 35%. Notwithstanding this reduction, the Government expects general practitioners to provide the same level of service.

This increasing reliance on the already overstretched public health service is a major source of concern, one which the Government is addressing in a dismal fashion. The permanent risk equalisation scheme is not nearly as effective as it needs to be compared to the systems in operation in countries such as the Netherlands and Switzerland. I understand the latest figures indicate the scheme is about 55% effective. Perhaps the Minister might indicate the precise figure.

One certainty is that community rating will not prevent the health insurance system from collapse. The Government must acknowledge this. On introducing the permanent risk equalisation scheme, it claimed it was protecting affordability for those most in need. According to the Department, the Government is committed to keeping down the cost of health insurance for as many people as possible. In that case, why is it pursuing a policy that is completely contrary to this objective, as many commentators and experts have noted?

Funds from private health insurance companies are effectively propping up the public system, yet from what I can discern the Government is intent on hacking away at the sustainability of the market. It has been estimated that the health levy has increased by 149% for an adult since its introduction in 2009, with the rate for children increasing by 155%. It has been claimed that charging private patients the full cost of using public hospitals will result in another price hike. Some believe the market could shrink by 40% in the coming years if premiums continue to rise. Only last week, the Minister called on insurers to absorb the cost of stamp duty increases, which the companies argue will result in an increase in premiums of approximately 15%, although I doubt the accuracy of that figure.

Despite the consistent policy of pushing up premium prices, the Government has not shown any willingness to tackle underlying cost pressures in the sector. For example, hospitals are still fraudulently charging insurers in the region of €1,000 for patients who are sitting on chairs and trolleys in emergency departments. This charge is levied in addition to the public service charge patients are required to cough up before they may even pass reception in accident and emergency units. That is outrageous.

The description of private health care in Ireland needs complete revision. Those who are lucky enough to have a private health insurance policy incur substantial costs if they are referred to a private consultant before their insurance kicks in. Last week I cited the example of a lady who had visited a consultant to have an injury to her hand diagnosed. The consultant who had been paid €150 or €160 for the consultation then charged the lady a further €300 to provide a letter the insurance company had requested setting out the diagnosis. He did so in the knowledge that the lady would submit a claim to her insurance company. The Minister is aware of this outrageous practice, yet consultants are able to get away with it. They can pluck a figure from the air on the basis that their patient will receive €10,000, €20,000 or €30,000 in compensation.

The cost of health insurance has doubled in the past two years and now averages €2,500 per annum for two adults and two children. It has been predicted that 75,000 people will leave the health insurance market this year. As people leave the system, the public health service comes under even greater pressure. The current position is unsustainable.

It is Government policy is to implement a system of universal health insurance by 2016. It is a wonderful policy, but, according to Laya Healthcare, 76% of medical professionals believe the Irish health system, in its current form, fails to protect patients and ensure best outcomes. How could it? Since 2008 almost 10,000 staff and 1,700 beds have been removed from the public system, yet it emerged in recent days that the HSE had agreed to keep quiet about perks, allowances and pension top-ups worth €3.2 million for top earners. Perhaps the Minister might confirm whether a directive from the Department of Health to cease making these bonus payments has been followed through. It will be interesting to know if that has happened.

We are nowhere near having a fair, just and fully regulated health system of which the Minister has so often spoken. By the way, I believe he believes in a fair and just system. The problem many of us have is how he can deliver it. Private health care is being put beyond the means of increasing numbers of subscribers. We have yet to see any meaningful reform of how we pay for health care in a fair and equal manner and confidence in the public system is being hacked away. The Minister need only speak to any person who has private health insurance. He or she will tell him he or she is struggling and keeps it because he or she needs it. If he or she could find some way out of it, he or she would take it. Owing to the public finances, we are not in a position where everybody turns to the public health system because if people did, it would collapse, particularly because of the significant numbers in receipt of unemployment benefit. The 450,000 unemployed all avail of the public health system, which means that we must put billions of euro extra into it. As public confidence erodes further, the problem is that while few would want to leave the private health system, people will find that they have no option but to do so.

I made this point earlier and will make it five or six times again. How does the Minister allow consultants to act in the way they do in the example I gave? How does he allow them to rip off ordinary people in the way they do? How can it be that a consultant would make such a request? When I heard of this, I thought it extraordinary that the consultant, having examined the lady concerrned and after she had paid him to examine her, would ask her, because she wanted a letter detailing what he had said to her in the examination, to give him another €300 for the letter. That is appalling.

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