Denis Naughten (Roscommon-South Leitrim, Independent) | Oireachtas source

I move amendment No. 1:

In page 4, between lines 2 and 3, to insert the following:"(3) Paragraphs (b) and (c) of subsection (1) shall, cease to be in operation on and from 1 January 2015, unless a resolution has been passed by each House of the Oireachtas resolving that that section should continue in operation.".

The objective of this amendment is to provide that the hospital bed utilisation credit shall be subject to a sunset clause. The credit was introduced 12 months ago partly as a means of distributing the risk equalisation fund. That accounted for a small proportion of it, but a proportion of it nonetheless. The intention here is to use it as an indicative measure of the actual level of compensation that will be provided to insurance companies. This is not being introduced out of the sky. The objective is that down the road, it will provide a mechanism for evaluating health status. I do not think it is a good measurement of health status. The Minister agreed with me 12 months ago that this not a good mechanism for health status. I proposed a sunset clause at that time.

The Minister felt there was no need for that because we were moving to a far more elaborate system of evaluating health status.

The objective behind it is to be able to differentiate among people who have private health insurance between those who are sick and those who are not putting the same demands on their health insurance policy, rather than the current age-related system. Age-related distribution of the fund is not a very effective way to do it because there may be younger people with chronic diseases who place a far greater burden on the health system than a 79 or 80-year old person who has been active all his or her life and is fit and healthy. Yet this is how it is being distributed at the moment.

We need a system that evaluates health status based on the physical health or mental well-being of that individual. It needs to have an inbuilt incentive to keep people out of hospital. All in this House agree that whatever incentives we have in our health system should exist to try to treat people as close as possible to their homes and to treat them outside the acute hospital setting in so far as possible. The Bill sets in statute the exact opposite. It recognises people who are treated within the acute hospital system. As we know increasingly those people are being treated in regional centres of excellence rather than in their local hospitals. On Committee Stage the Minister pointed out to us that this calculation will not include day procedures. As we know, the increased throughput in many of our small hospitals is down to day procedures.

I am sure the brief before the Minister of State on this matter states that this has a negligible impact on the overall cost of health insurance and is only being used as an indicative measure. However, if we could move to a proper system of health status and move away from the age-related credit we have at the moment, we could have a far more effective and hopefully balanced system of community rating without the continual upward pressure on insurance premia we have at the moment. In January those who typically are on VHI plan B will face an extra €259 per person on their policies. That is a significant increase in the cost of health insurance for an elderly couple on a fixed income, particularly for those who have paid into their health insurance over 40 or 50 years and may have had a very healthy lifestyle over that period. They are now being priced out of the health insurance market. The introduction of health status as a weighting mechanism makes far more sense.

There is no sense of urgency in the Department of Health to introduce a realistic mechanism for health status. I understand it cannot be introduced overnight, which is why I made the argument 12 months ago for introducing a sunset clause to the hospital bed utilisation credit that would kick in 12 months later. I again make that proposal. The responses I got from the Minister on Committee Stage did not indicate there had been any progress in developing clear criteria to evaluate health status. Perhaps the Minister of State, Deputy Kathleen Lynch, can enlighten me when she responds as to whether progress is being made on that. If that is the case I cannot understand why she could not support the amendment. Let us put in the clause, as it would give an incentive to the Department to ensure this system is put in place. The health insurers advise me that they could in conjunction with the hospitals put such a system in place within 12 months.

See this speech in context