Kathleen Lynch (Cork North Central, Labour) | Oireachtas source

In the past our health system has suffered - I hope it will not suffer in the future - from decisions being made too quickly and not based on evidence or clear criteria.

The hospital bed utilisation credit, provided for in the Health Insurance (Amendment) Act 2012, was payable in respect of each overnight stay in a hospital bed in private hospital accommodation by an insured person where the health insurance cover of their contract covers that hospital stay. The Bill provides that this credit will also be payable from 1 January 2014 where a private patient occupies a public bed and there is a charge payable under section 55 of the Health Act 1970 for such stay. The definition of "relevant amount" is amended to provide that the amount payable in respect of hospital bed utilisation credit covers each overnight stay in a hospital bed where a charge is payable under section 55 of the Health Act in respect of a private patient in a public hospital bed.

The Deputy's proposed amendment would have the effect of ceasing the payment of the hospital bed utilisation credit in respect of private patients occupying a public bed from 1 January 2015 while the payment would continue in respect of a private patient occupying a private bed. The resulting inequality is not desirable and while I expect that is not what the Deputy had in mind, I will not in any event be accepting the amendment.

The hospital bed utilisation credit was introduced as a proxy indicator of health status, pending the introduction of a more refined health status measure. The Deputy is quite right in that; it is exactly what it is. Unlike the age-related credit which is payable in respect of all members aged 60 years and over, the hospital bed utilisation credit is payable in respect of all qualifying insured persons who have an overnight stay in a hospital bed so all insurers benefit. However, the Minister is committed to introducing a more refined measure of health status, for example through the use of diagnostic related groups, as is the case in many other countries. I am aware that the consultative forum on health insurance, comprising representatives from the industry, the regulator and the Department is committed to working together to overcome the obstacles that existing information deficits present to the development of a robust measure of health status. I am sure the Deputy knows - as would anybody with an interest in the health area - that our information gathering has not been the best and we need to refine and enhance it.

The Deputy sought to introduce a sunset clause for hospital bed utilisation credit last year. Each year the rates contained in Schedule 3 and Schedule 4 are amended by primary legislation when, in line with Deputy Naughten's desire, the Houses of the Oireachtas have an opportunity to debate it. When a policy decision is made to discontinue the hospital bed utilisation credit the rate will be amended to read "nil". This is a more appropriate method of dealing with the issue in legislative terms rather than what the Deputy may have sought to achieve.

However, I agree with the Deputy that we need to move to a more refined indicator of health. He is equally right in terms of people's health status given that it is possible to have a chronically ill 20-year old and an extraordinarily healthy 80-year old. While more refined indicators are needed, this is just a mechanism to ensure we have some balance in risk equalisation and who pays.

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