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

Relative to other countries, health insurance is held by a large proportion of people in Ireland. It is important to take the opportunity to discuss this Bill and the positive effect that community ratings and other aspects of health insurance regulation have on people's daily lives. As stated earlier, Sláintecare will introduce change in how people access health services and may mean that the role of private health insurance in our health service will also change. The Bill supports the role that private health insurance currently plays in our health service as a means of supporting people's access to affordable healthcare. The main purpose of the Bill is to specify the revised risk equalisation credits and corresponding stamp duty levies to apply on health insurance policies from April 2019.

The voluntary health insurance system operates on the basis of community ratings, which means that everyone pays the same amount for the same product. This is supported by the scheme that aims to ensure that health insurance is more affordable for older and less healthy citizens. In other health insurance systems internationally and other insurance markets in Ireland, the level of risk presented by an individual directly affects the premium paid.

Under this scheme, all of the money raised from the insurers in levies is paid into a fund for the sole purpose of supporting the market in the form of credits payable. The credits and levy rates for next year strike a fair balance between the need to sustain community ratings by keeping health insurance affordable for older and less healthy consumers and maintaining the sustainability of the market by keeping younger and healthier consumers in it.

Of course there are important aspects to this debate, as the Deputy rightly says, concerning Sláintecare, public healthcare and public hospitals. Arising from the recommendation in Sláintecare, the Minister has established the independent review group, IRG, to examine the removal of private practice from public acute hospitals. The IRG has been tasked with making recommendations on practical approaches that can be taken to remove private practice from public hospitals, the impacts of this removal will have, what timeframe might apply and how to phase these changes in over time. In particular, the group will identify any adverse unintended consequences that may arise for the public system in the separation. The IRG also conducted a public consultation seeking views about the current arrangements governing private practice in public acute hospitals, the future direction that such arrangements should take and suggestions for transitional arrangements to give effect to the future direction.

In particular this group was asked to seek views on the following important issues: eligibility, access and equity; current and future funding arrangements; legislative and legal issues; operational matters, including specialist services; recruitment and retention of personnel; and practical approaches to the removal of private practice from public hospitals, including timeframe and phasing. That issue is being examined in the IRG. This group has met many stakeholders with a view to increasing its understanding of the issue. It is also considering private care provided in public hospitals which is currently funded by private insurance.

The Bill will increase the number of Health Insurance Authority board members from five to seven. This provision will ensure strong oversight and regulation of the health insurance market. The Bill will also see some changes introduced with regards to VHI. The first change is in the composition of the VHI board. The proposed amendment would remove the existing restrictions allowing only two persons who are health service providers on the board. The amendment will also allow for due consideration of the mix of skills present on the board.

The second change is to permit VHI to sell international healthcare plans directly, without an intermediary. The Bill also allows us to maintain our support for the core principle of community rating, which is long-established and well supported Government policy for the health insurance market. The Bill will ensure that we can continue to provide the support necessary to ensure that the costs of health insurance are shared across the insured population. I agree with the Deputy that we need to have a broader debate and examine the issues raised by the independent review group, particularly with regard to the removal of private practice from our public acute hospitals.

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