Leo Varadkar (Dublin West, Fine Gael) | Oireachtas source

I thank Deputies for their contributions and broad support for the Bill. Its main purpose is to specify the risk equalisation credits, including a 50% increase in the hospital bed utilisation credit from €60 to €90 per night, and corresponding stamp duty levels from March 2015. In addition, the Bill will specify the allowable rate of net premium payable in respect of young adults, provide for the transfer of insured persons from a restricted membership undertaking without the application of any additional initial waiting period and make some other technical amendments to the Health Insurance Acts 1994 to 2013.

I would like to respond briefly to some of the issues raised, although many of them do not relate directly to the Bill. Deputy Kelleher raised the issue of universal health insurance, UHI. When I was appointed I took it upon myself to review the progress made to date and timescales for the implementation of a number of important reforms, including UHI. I remain committed to the important reforms the UHI system is intended to bring in but I do not believe it will be possible to have the full system in place by 2019, as envisaged by the White Paper. I intend to push ahead with key reforms such as GP care without fees for the youngest and the oldest in our society, the implementation of activity-based funding formerly described as "money follows the patient" and the development of the hospital groups, all of which are key steps on the path to universal health care.

Following the publication of the White Paper, a public consultation process was initiated and 137 submissions were received from members of the public and other stakeholders. An independent thematic analysis of submissions was received last month and that will be published in the future. In addition, a major exercise is now under way to estimate the cost of universal health insurance to the State, to individual households and to employers, and that has commenced. This work is being led by the ESRI and when I receive the results of this, which I expect to receive in the first quarter of 2015, I will then be in a position to make a presentation to the EMC and Cabinet sub-committee to set out the detailed next steps on the road to universal health care should the rationale for that remain in place.

As we all know, Ireland has a mixed hospital system where both public and private services are provided in public hospitals. The HSE has put in place specific measures to address waiting lists more efficiently in collaboration with acute hospitals, the SDU and the NTPF. These include strict observation of the national waiting list protocol, including strict adherence to chronological scheduling and biannual validation of lists for all patients waiting more than three months; adherence to the relevant HSE national clinical care programmes; flexible usage of theatre capacity with and between specialties; the introduction of centralised booking systems; pooling of lists, where appropriate; prioritising day surgery and admission on the date of surgery even if it is not day surgery; pre-admission clinics; and referral back to GPs for monitoring where possible. New pathways of care continue to be introduced to improve patient flow through hospitals, including, in particular, medical assessment, minor and local injury units, and urgent care centres, as well as the provision of care in non-hospital settings, which are increasingly used to provide a spectrum of care which supports the efficient use of hospital resources.

I welcome the Deputies' suggestions about retaining staff in the Irish health service. We are having difficulties holding on to nurses and doctors. It has always been the tradition that doctors and nurses emigrate, often to gain experience, but they tend to come back. They are not coming back in the numbers they used to for a number of reasons. It is not just down to salaries, although that is part of it. It partially comes down to the frustration of working in a system that has been creaking for the past number of years. I hope with the service plan published today and the first modest increase in spending in seven years that we will see some improvement in that regard and more hope across our health service. I note the suggestion that was made that we waive or pay the fees for people who agree to stay. There is some merit in that but, unfortunately, if we did it now, it would not produce results for a number of years or for at least a year, and there would be the argument that it should also be applied in other sectors where there are difficulties in recruitment. I welcome a positive suggestion and it is one that merits some thought.

It has also been mentioned that insurers should make more use of clinical audit to ensure the appropriate treatment of private patients. The McLoughlin report on the measures to reduce costs in the private health insurance market made a number of important recommendations, including the use of clinical audit. Insurers already have improved clinical audit, however. I agree that there is much more scope for improvement and I will be engaging with insurers on this issue through the Consultative Forum on Health Insurance.

In addition, when it comes to fraud, waste and abuse, the private health insurers have agreed to use existing anti-fraud and confidential hotline structures to facilitate combatting fraud in the private health insurance market.

This Bill, taken with the series of measures I announced to address the rising cost of health insurance premiums, are designed to work as a package. I want to make health insurance more affordable again for as many people as possible in a sustainable market and to try to limit the need for future increases. Following a lengthy period of rising premiums and a severe decline in health insurance cover the number of policyholders is for the first time in a long time increasingly slightly, with an increase of 1,000 in the number of people insured in the period July to September of this year. I hope these new measures will allow this trend to continue and that insurance companies will respond favourably.

I commend the Bill to the House.

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