Mary Butler (Waterford, Fianna Fail) | Oireachtas source

I thank the Deputies who indicated their support for the Bill. I also thank the Deputies who spoke in the debate today and yesterday for their contributions. I will only speak and comment on issues related to the Bill.

As was discussed in yesterday's debate, a large number of people hold health insurance. For some, this is a choice while others, unfortunately, may view it as a necessity. The Government is committed to improving public health services under the Sláintecare programme.

As access to these services improves and the public's confidence in public health services increases, it may be that we see a change in the numbers that hold health insurance. In addition to providing support to community rating, the amendments to the risk equalisation scheme have regard to the sustainability of the market and the need for fair and open competition. Importantly, they also ensure that there will not be overcompensation of any insurer from the scheme, as required under the EU framework for state aid. The Bill 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 necessary support to ensure that the costs of health insurance are shared across the insured population.

Various issues were raised over the past day or two. My officials have said that they will take a look at the issue of restricted membership undertaken, which was raised by Deputy O'Reilly. Many Deputies spoke about the number of people who have health insurance in this country, which stands at 46% of the population. It is important to put on the record that while a large number of people hold private health insurance, and this Bill provides support for them, to also draw Deputies' attention to the number of people who are able to access public healthcare without having to pay. As of 1 November 2021, 1,563,184 people in Ireland hold medical cards. This represents 31.2% of the population. Some 525,813 people hold GP visit cards, which is 10.5% of the population. In total, these cards cover just shy of 42% of the population. This represents massive funding for public healthcare in Ireland.

Many Deputies also referred to Sláintecare. The Sláintecare Implementation Strategy and Action Plan 2021-2023 was approved by the Government in May. The six-month progress report published last month indicated that of the 112 deliverables, 109 were on track or progressing with minor challenges. I expect the progress to continue at pace in 2022, supported by the allocation in budget 2022 of €21 billion, the biggest ever investment in Ireland's health and social care service, to deliver Sláintecare. I also want to touch on the roll-out of the vaccine because it epitomises what Sláintecare is all about. Some 8.2 million doses, free at the point of entry with access to all, have been rolled out. I take this opportunity to encourage anyone who is entitled to a third vaccine, or a booster shot, to take it up.

Deputy Shortall mentioned the benchmark of reasonable profit. In 2016, the benchmark of reasonable profit was set at a 4.4% return on sales following a benchmarking exercise among European insurers with a similar profile to the net beneficiary of the Irish risk equalisation scheme, which is VHI Healthcare. An overcompensation test is conducted for every three-year period to make sure that the net beneficiary of the scheme does not make more than the reasonable profit figure. A new benchmarking exercise was conducted among Irish and European health insurers and the Health Insurance Authority recommended the 6% figure, which is at the low end of the recommended range. The 6% return on sales figures will only apply to the net beneficiary of the scheme, which for the foreseeable future will be VHI Healthcare. While VHI Healthcare operates on a mutual basis and all profits are reinvested in the company's products and services for the benefit of its customers, it is conceivable that a company which operates on a for-profit basis would become a net beneficiary in the future. To provide for that circumstance, it is necessary to review the benchmark to make sure that it is appropriate and to provide that an insurer with a worse risk profile than its competitors is not being further disadvantaged by keeping its profits below a competitive figure.

I will also touch on the role of private health insurance in Sláintecare. Removing private care from public hospitals remains an incremental and progressive long-term objective of Sláintecare. This process is aligned with other reforms being progressed under Sláintecare allowing more time to put in place the necessary improvement in capacity and care models. One of the recommendations and milestones yet to be achieved is the implementation of the Sláintecare public-only consultant contract. Negotiations on this contract are currently ongoing. The programme for Government contains a commitment in respect of the finalisation of this contract and the introduction of related legislation to support public-only work in public hospitals. The impact of implementing the removal of private care will happen progressively. Anyone with health insurance can continue to receive private care in public hospitals for the foreseeable future. After that, anybody with private health insurance will still be able to receive private care in private hospitals. I was asked last night by Deputy Kenny if I believed in Sláintecare; I absolutely do. I quote from it every day when I am talking about my brief on older people and mental health. It is about providing the right care, at the right place, at the right time and as close to home as possible.

There was a lot of talk last night about waiting lists. The Department of Health, the HSE and the National Treatment Purchase Fund, NTPF, are focusing on improving access to elective care in order to reduce waiting times for patients. These plans include increased use of private hospitals, funding weekend and evening work in public hospitals, funding see and treat services where minor procedures are provided at the same time as outpatient consultations, providing virtual clinics and increasing capacity in the public hospital system. Under the NTPF, 122,000 outpatient appointments were approved by the end of October this year. Some 47,474 appointments were arranged and 26,730 patients have been seen at an outpatient clinic. The health budget for 2022 provided an additional allocation of €250 million, comprised of €200 million to the HSE and €50 million to the NTPF, in respect of work to reduce hospital and community waiting lists. The €250 million will be used to fund additional activity in the public and private sectors. The €50 million in additional funding provided to the NTPF brings the total allocation for 2022 to €150 million. As a consequence, a budget of €350 million will be available to support vital initiatives to improve access to acute hospitals and community health services.

One of the issues that has been raised with me on many occasions since I came into post is the length of the primary care psychology waiting list for young people. Unfortunately, when I was appointed last year, more than 5,000 over-12s were already awaiting supports. I received €4 million this year, for the period September to December, to try to put a targeted approach to waiting lists in place. All the community healthcare organisations were able to get consultants to work some overtime, hire locums and use both the public and private sectors to do so. We will meet a target of 20% of those on that waiting list, which means 1,000 children will be seen over four months. We have much more to do, but it is at least a start. I hope to secure more funding in the new year to keep that initiative going. I commend the Bill to the House.

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