Mattie McGrath (Tipperary, Independent) | Oireachtas source

The purpose of the Bill is to specify the amount of risk equalisation credits to be paid from the Risk Equalisation Fund in respect of age, gender and level of cover from 1 April 2020 and to make consequential amendments to the Stamp Duties Consolidation Act 1999 and to revise the community rating stamp duty levies required to fund the risk equalisation credits.

As I understand it this means that the Government is increasing the stamp duty paid by insurance firms on health insurance policies, which is the first increase in three years. As reported, the Government has said that the 1% increase of €5 in the stamp duty for policyholders with advanced contracts is not only necessary to support more affordable policies for older and less healthy people but also extremely modest, as the first increase in three years.

Why is this the first increase? Why is the increase that is being imposed on firms so modest? I am sorry I missed the Minister of State's opening speech but he might reply when he is finishing. We have seen the cost of insurance working group report on motor insurance that was supposed to provide greater clarity, certainty and transparency in respect of that sector. That has not happened by and large, as the evidence presented to the Committee of Public Accounts last week by insurance industry representatives made all too clear. Perhaps we need to think about developing a working group on health insurance.

Even Dr. de Buitléir, who signed off on the report on private practice in public hospitals, was clear that there is a significant problem about how we operate private health insurance in this State. He recently told the health committee that we are a complete outlier whereby 50% of people think they must have private health insurance, some of which is for non-advanced plans that only apply in a public hospital. Dr. de Buitléir went on to note that an international benchmark of almost 15% would be typical. Why are we at 50%? He said that we can get a high-performing public system with the Sláintecare programme and the private system can go off and supplement that or compete with it.

According to the Money Guide Ireland website, the health insurance market in Ireland is estimated to be worth over €2 billion in premiums each year. While we have a health budget of €17 billion, €2 billion is a savage amount of money, paid out of people's pockets. At the end of 2018 it was estimated that 43% of the population of Ireland had private health cover. The Money Guide Ireland website also notes that there seems to be strong loyalty or maybe just apathy about switching health insurance provider. It is very difficult for people to know if they are getting the same product or a different product or what they are getting for their money. We need to encourage people out of that apathy and encourage them to shop around more, but sometimes it is made so difficult and bureaucratic. I am sure the Minister of State knows it is bureaucratic and that he has health insurance. I have it. It is so difficult to move from the few that are there or to know if we are getting the same cover for the same bands of payment. It is trick of the loop as far as they are concerned. It is a cash cow for them. I know some unfortunate elderly people who gave up paying recently. They could not afford it. Then they get sick. They are paying it all their life and might only be gone a month when something happens and they have no cover. As I understand it, the average number of years policyholders have been with their current health insurance provider is 14. That must count for something. Five years is loyalty. Ten years is extra loyalty and 14 is huge loyalty. Only 22% of people have ever changed insurance provider, a very small percentage. Maybe the insurance companies are too cushy and too blasé and have a cavalier viewpoint towards the policyholders. The attitude is they will pay up. Where else are they going to go? They need to have it. There is a fear factor and so on. There needs to be a whole review and examination of what is going on. Only 20% of people with health insurance, one fifth, said they regularly shopped around for lower prices or better cover or both, which is shocking.

I remember when the health insurance started with the VHI and so on. People were so glad to get it and so fearful. We can understand now, especially with the public hospitals and the queues out the door and the shocking figures. There was a new record again today in Limerick, which serves north Tipperary. It is shocking. Everyone is shocked except the Ministers. I am referring to the senior Minister, Deputy Harris, not the Minister of State, Deputy Daly. Another new record today for failure and absurdity and the amount of trauma and stress on patients. We are not really in the winter at all yet. Consequently, the Government will throw €25 million at a winter programme. The whole thing is archaic. That is why people are so frightened and why they keep paying the private companies and are afraid to even shop around.

The Money Guide Ireland website notes the average cost of a private health insurance policy in Ireland, according to a 2017 survey by the Health Insurance Authority, was €1,858 a year. Over 35%, more than a third, were paying more than €2,000 a year. These could be policies for a whole family but it is savage money. Some 38% said they had never made a claim on their health insurance policies. The insurance companies cannot say the premiums are going up because of the claims.

The Health Insurance Authority has a price comparison facility for private health insurance in Ireland. A search on the HIA comparison site in October 2019 for cover providing a private room in a private hospital showed up dozens of different health insurance price plans available for a single adult. Why is that? Visitors coming to our capital city are being charged extortionate rates for hotel rooms but this is a different matter. As I said, the HIA comparison for October 2019 for cover providing a private room in a private hospital showed up dozens of different health insurance price plans available for a single adult. Who would want to bring the family in there? For a single room, for a single adult, prices ranged from the cheapest at €910 per adult per year to the most expensive at €4,866 per adult. It is shocking money. The number of different plans and variations in levels of cover provided is mind-boggling. It must be easy for people to get confused by all the options available. One keeps getting options until one is out of options.

It is so sad, especially for elderly people who are not be able to go on the web or to google and check out the best value. It is unbelievable that they are charged that kind of money. The amount of different plans, variations and levels of cover provided is mind-boggling. I reiterate it must be easy for people to get confused.

The lowest-priced plan shown was €910 for the Control 600 Connect from Laya Healthcare. This Laya policy has a €600 excess on each inpatient claim. Outpatient consultant visits get €40 each, GP visits get €20 each and accident and emergency department cover excess is €20. One is paying the insurance where one must pay up "hello" money as well. The best option, if people can do it here, is not to get sick or go anywhere, because one is fleeced. The loyalty policy has a €600 excess on each payment claim. If one considers contributions to outpatient consultant visits and GP visits of €40 and €20 each, respectively, this compares to some GPs, who only charge a fee of €40 in any event. This is crazy.

There are also ongoing issues for the kind of insurance that medical practitioners require. There is a chronology to this since the establishment of health insurance and the VHI in 1957. A liberalised market was promised when the third life assurance directive was transposed into Irish law on 29 November 1994. It was supposed to force competition and reduce prices in the area of private health insurance. Like everything else, it is supposed to drive competition and better value but it does not happen. Why in this country do we celebrate Comóradh Céad Bliain na Chéad Dála, when everything is such a rip-off? We are promised all of this but do not get it. Do they take people for complete patsies and fools? There is no public service out there. I should not be knocking everything as there is a service, when one gets into the hospital, but trying to get into the accident and emergency departments is abysmal. It is a horrible, desperate experience. A new record was announced in University Hospital Limerick today, which serves half of my county. There is not a mental health bed in the whole of County Tipperary. The Minister of State is aware of this as he has tried his best but is unable to change it. That it is a sad reflection, but not on the Minister of State himself.

It is a reflection on those with their hands on the handlebars of power, the senior officials and the HSE. One would need a hammer and chisel to get it off them. They, the permanent government, are in charge and they do not care. Instead of serving the public, many of them are self-serving and are driving to ensure that they get promotion and positions for themselves. The Minister of State, saw that for himself in Clonmel, when he was with me last week, where we saw a hospital full of offices and another hospital that is closed but is full of offices. Of the 300 beds I mentioned that day, some 900 beds have been lost in Tipperary in the last 15 years. These facilities are all full of officials. The beds are gone, having been taken over and upgraded to a high standard, and still we do not have a single mental health bed. There is something rotten in the state of the HSE in this State in that regard. It is disgraceful.

A liberalised market was promised when the third life assurance directive was passed in 1994. The Health Insurance Act 1994 made provision for the establishment of the Health Insurance Authority but the body was not brought into existence until a long time later, in February 2001. Why did it take so long? Why are the people being treated like this by this Legislature? We were promised this authority in 1994 but the body was not brought into existence until 1 February 2001, a long time later. Who was in charge? The Minister of State was not here, nor was I. What is going on? I believe this to be deliberate policy, not of the legislators, current or past, many of whom were just passing through at the whim of the public, who elect us. Thankfully, they have elected me. I have to ask why it took this length of time for this body to be appointed when it was promised with the legislation?

The 1994 Act was amended by the Health Insurance (Amendment) Act 2001, providing for, among other things, an enhanced role for the HIA, with more responsibility than envisaged under the 1994 Act. I welcome that. The HIA is funded by a levy imposed on private medical insurers but this, like everything else, is passed down to the punters. He who pays the piper calls the tune. That is the way it should be but it is not what happens, it is just passed on.

The role of the HIA includes acting as a registrar of medical insurers and undertakings and vetting new market entrants. It is also involved in consumer protection and provision of information and provides advice on matters of medical insurance to the Minister for Health. The HIA receives returns from medical insurers every six months and on that basis, makes recommendations to the Minister regarding risk equalisation, which is what the Bill before us deals with and which I hope this Bill will do. I do not understand why insurers cannot see that these increases are creating an even bigger mess. The drop-out rate from health insurance is enormous. Why would it not be? All is not well and I appeal to the Minister of State to do what he can to sort it out.

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