Finian McGrath (Dublin North Central, Independent) | Oireachtas source

I thank the Leas-Cheann Comhairle for the opportunity to speak on the Health Insurance (Amendment) Bill. This is an important debate and I am glad the Minister, Deputy Varadkar, is in the House. It is important, when discussing this legislation that we not only analyse the Bill, but also put forward suggestions for reform.

For too long, this debate has gone on and it is time to deal with the real reform agenda, both in the area of health insurance and in the broader health service. Whether we like it or not, health will always be an important issue and it will always be on the political agenda. One can always judge a society by the way it treats its patients and runs a health service. We have seen in recent years the huge crisis in health insurance services.

Before I get into the details, I welcome the reforms of the medical card issued yesterday. I genuinely hope that theses will work because we must ensure that sick and disabled children are guaranteed a medical card as a major priority.

We also must look at the broader issue in particular hospitals that have to deal with a crisis of patients on trolleys seven days a week. We have to do something about that. Despite the Government talking for the past four years about that issue, the situation is as bad as ever. It is not good enough. In my constituency, Beaumont Hospital urgently needs supports. They need a quality system that will free up the beds for many patients who are stuck in accident and emergency not only on trolleys, but also on chairs.

Some nights one cannot even get a chair. I know that from direct experience myself because over a year ago I spent 24 hours on a chair before I eventually got into the system. We must face the reality in that regard.

We are discussing health insurance and reform of the health service but I wish to take the opportunity to refer to the disability sector. The sector has been penalised for the past four years due to repeated cuts. The Minister has an opportunity to put disability back onto the agenda and to reinstate and develop disability services. We, on this side of the House, will support him. The efficient management of resources is required. I strongly support such an approach.

We should take a broader view in the course of the debate. The health service should never be looked at as if it is just another business service. It is not a private business. We must accept that. Changes are required to be made very quickly when a crisis occurs such as flu or other epidemics such as Ebola. We must ensure we have the infrastructure to deal with issues as they arise. I do not enjoy listening to people prattling on as if the HSE is an SME when it is a health service. Like many colleagues, I firmly believe we should have a broader, universal health service that is paid for out of general taxation. That is part of my political vision for this country.

Currently, 700 people are in hospital who should be in other caring environments. If the matter were addressed, it would immediately free up hospitals beds which are urgently required in many hospitals. We must be radical, reforming and creative.

A total of 250,000 people dropped out of the private health insurance market in the five years to the end of 2013. Increases in premiums ranged from 7.3% in 2011 to 12.1% in 2012. In 2008, the average premium paid per insured person was €729, but in 2013 the average premium had increased to €1,050, representing a 58% increase in the period 2008 to 2013. That is an absolute scandal. Families are being hammered left, right and centre. Politicians wonder why people are very angry with the Government and disillusioned. Another reason for their anger is the significant increase in the premium for private health insurance. The average cost of claim per insured person increased by 12.6% per annum between 2008 and 2012.

The age structure of the market saw a significant ageing of the insured population. In 2003, a total of 13.3% of the insured population was aged over 60 but that had increased to 19% of the insured population by the second half of 2012. We must plan for the fact that people live longer. That is fantastic news, but we must also develop a long-term approach to deal with such issues in the health service.

The number of people in this country with health insurance was in decline from 2009 to the middle of 2014 but since then there has been a small increase of 1,000 people. However, people have major concerns about the overall decline and in particular the age profile of people with health insurance cover and the impact that might have on the sustainability of the health insurance market as a whole. We must be conscious that the health service is not a private business and things change by the moment. People live longer, cures are found and there is a general improvement in the quality of life. That is the case for approximately 70% of people, which leaves 28% of the population who are in a severely disadvantaged situation, who impact on the health service. There are also health implications for the 28.6% of children who were living in poverty in 2014. We must address the issue of economic disadvantage or we will have more problems in the health service and more people using the health service.

The market has also been affected by the increase in premiums and claims at a time of reducing income among consumers. In 2012, a consultative forum on health insurance was set up, which I welcomed at the time, as I considered it a very important development. We must get people involved who know the issue in a bit more detail. The Minister for Health has appointed a new chairperson, Pat McLoughlin, and the forum has already produced two reports. We must ensure that the reports and positive aspects of the legislation are included in the broader debate on health insurance.

The legislation seeks to amend the existing health insurance legislation. The principal Act is the Health Insurance Act 1994. The Bill also introduces a system of graduated discounting of health insurance plans for young adults aged between 18 and 25 years, inclusive. It would also permit an insured person to move from a restricted membership insurer to another registered insurer without an additional waiting period. I welcome the change.

As part of an annual process of adjustment, the Bill seeks to specify the amount of risk equalisation credits payable and the amount of hospital bed utilisation credit applicable from March 2015. The Bill also seeks to amend stamp duty levies and some technical amendments to health insurance legislation. These measures are designed to address the increase in premiums and stabilise private health insurance in the interests of consumers. I support the approach, which is sensible. The key point is that we must protect the interests of consumers – I prefer the term "citizens". I am concerned that our focus is still too much on a two-tier health service. We must deal with the immediate problem in terms of the Bill before us and the impact of market forces. However, we must also look to the longer term. For me, that means a universal health service.

The Minister probably would not agree with me but if he wants to see a good quality health service in a very poor country, he should take a trip to Havana for that purpose.

See this speech in context