Mary Butler (Waterford, Fianna Fail) | Oireachtas source

I thank the Deputy for his contribution to yesterday's debate which highlighted the role model 2 hospitals can play in providing care to the community. However, I must reject the amendment and will outline the reasons for the rejection.

The provisions being introduced in this Bill on high-cost claims are the result of significant work carried out by the Health Insurance Authority in the past few years. The authority provided its recommendations to the Minister for Health in June of this year and as a result, we have the definition in the Bill, which excludes drugs not approved by the HSE and takes into account other credits claimed from the fund.

To include the Deputy's amendment would introduce additional requirements for high-cost claims credits which have not been planned or factored into the authority's recommendations for other credits or the stamp duty. I also note the coverage of model 2 hospitals was not raised in the public consultation on the new scheme, which was conducted in January of this year.

The proposed amendment raises a number of concerns. First, the legal consequences of a change in the Act would effectively compel insurers to change their existing cover of hospitals and this would lead to an increase in premiums for consumers. This would also be an additional element for the new scheme which has not been notified to the European Commission and which could have knock-on effects on the negotiation process. The scheme was notified to the Commission in July and does not include the requirement that model 2 hospitals have to be covered for high-cost claims credits to be paid out. Amending the Act to include cover for all model 2 hospitals would introduce a favoured category of public hospital, which is not appropriate for the health insurance Acts. Model 2 hospitals are intended to have a role in providing a medical assessment unit and local injuries unit, as well as elective care. It is intended under Sláintecare that there will be no private activity in public hospitals, including model 2 hospitals. In answer to the concerns the Deputy raised yesterday, it is not intended that model 2 hospitals will be used as a testing ground for the policy. It will apply to the whole public hospital system, not just model 2.

Department of Health officials have surveyed the insurers and confirmed that the majority of plans across all insurers provide cover for model 2 hospitals. Those that do not are entry-level plans which still provide cover for some model 2 hospitals. These entry-level plans are intended for entrants to the market at an affordable rate. Forcing cover for all model 2 hospitals would have the unintended impact of driving up the price of entry-level plans. These are plans that are unlikely to lead to high-cost claims, which are to be covered by the definition the Deputy is trying to amend.

It is important that people who want to buy health insurance are clear on what they are buying. Health insurers generally issue suitability statements to make sure the customer is aware of where they are covered and is buying the right level of cover for that individual. Applying this amendment to the Act would be counterproductive and in direct contravention of Sláintecare's aim of ultimately removing private care from public hospitals. Public health policy recognises and is committed to securing and developing the role of smaller hospitals but this amendment would not further this aim.

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