Martin Browne (Tipperary, Sinn Fein) | Oireachtas source

I too welcome the opportunity to discuss the Bill. We will support it, given the large number of people who are reliant on private healthcare providers to receive care in a timely manner. Risk equalisation, which the Bill will provide for annually, ensures costs will be constant across the lifespan of the individual. It seeks to ensure that, where possible, age, gender and health status will not influence the cost of an insurance product. Let there be no doubt, however, that this support is not immune to our misgivings, given the two-tier health system that results for some people, whereby they can find themselves carrying the cost burden of private health insurance because they cannot trust the health service to deliver care in as timely a manner as they should be able to receive it.

The level at which people are reliant on it is reflective of the problem people use it to address. Currently, almost half of the population is covered by private health insurance. It has tapered off from its peak in 2008, when it was at 51%. As a consequence of the economic crisis, the level fell to 44%, but the number availing of it has again increased and stood at 47% last year. The question must be asked as to why so many people are finding themselves with little option but to fork out this substantial cost for private health insurance. The answer is obvious: hospital waiting lists are unacceptably long, patients wait months and years to receive the treatment they require, and those who are at the beginning of the process can, in many cases, find themselves spending lengthy stretches of time in emergency departments.

The emergency department at UHL is a case in point, while only yesterday, Tipperary University Hospital had to appeal to people to stay away where possible unless there was a genuine need to visit an emergency department. More and more people are having to opt for private healthcare to get not just an assessment of need for their child but also the services of which they are identified as subsequently being in need. This is just one example of where the failings of the public system result in parents having either to rely on health insurance or, more likely, to use whatever savings they have, or to get a loan from the credit union to access in a timely manner the care or treatment they need.

At the other end of the scale, this makes no sense to me whatsoever, beds are removed from communities only to be replaced by a reliance on the private sector. Again, I have a local example of this with the closure of St. Brigid's Hospital in Carrick-on-Suir, where beds were closed, with some of them contracted out to the private sector. This matter has been repeatedly examined and discussed, yet it still makes no sense as to why private providers that are farther from the community in which the beds were originally located are seen as a better option.

Also, the fact nearly half of people have private health insurance would lead an outsider to conclude this level of reliance on the private sector means the public system has a significant level of demand lifted from its shoulders and must therefore be in a better position to provide for its patients. This is obviously not the case.

Given we have such a high level of people availing of private health insurance, We must ask why the public system is still buckling. The answer is decades of mismanagement from the Department. Ultimately, the fact so many people find themselves in need of private health insurance to the extent they do is an indictment of this Government's failure in the overall area of healthcare provision and access. Moreover, the fact that despite this level of private healthcare take-up, the public system is still buckling is a further indictment. I could also add to this the Government's reliance on outsourcing to the for-profit healthcare sector as a third example of how the health system under this Government is unable to meet the demands it should. All this results in an unequal access to healthcare and while the system as it is must have the private sector to fall back on in times of need, we really must aim for better. We need to increase capacity. We need to stop removing beds from the community settings that would otherwise help take the pressure off our emergency departments. This would help reduce the deterioration of conditions that otherwise could see an increase in waiting lists and therefore waiting times. The ambition to reduce our reliance on the private sector is one that must be given more weight.

To conclude, Sinn Féin will table amendments to the level of reasonable profit this Bill makes provision for. This Bill seeks to increase the benchmark amount of reasonable profit, which is the level used in the assessment of whether an insurer has been overcompensated by the risk equalisation scheme. The proposal here is to increase this to 6%. We will be calling for this to be limited to 4.4%, which is the lowest level and was set from 2016 to 2020.

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