David Cullinane (Waterford, Sinn Fein) | Oireachtas source

This is an annual Bill to review the risk equalisation mechanism that supports the community-based health service insurance market. It revises the stamp duty levy on policies and the risk equalisation credits payable to insurers for 2025. Risk equalisation as a principle ensures that costs are constant across the lifespan of the individual. It seeks to ensure, where possible, that age, gender and health status do not influence the cost of an insurance product. This legislation is required each year to revise the system of credits and levies to ensure the risk equalisation scheme operates in a consistent and fair manner, while also generating sufficient income to ensure it is self-financing. Recognising the reliance of so many people on health insurance, we will be supporting the Bill, as we have done in previous years.

I will be tabling an amendment on Committee Stage to limit the reasonable profit for providers to 5%, which is similar to the rate of reasonable profit from 2016 to 2020 until for some reason, this Government increased it to 6% and higher. At a time when so many families are facing significant cost pressure, when premiums are rising because of runaway health inflation and when 47% of the population rely on private health insurance because of our failure to fix the health service, it is incumbent on private providers and insurers to do their bit to ensure affordability for ordinary workers and families. The high level of health insurance cover across the population - 47% - is in many ways a damning indictment of the Government's failure to deliver a single-tier public health service that is fit for purpose. As the Minister will know, many people take out private health insurance not because they want to but because they feel they have no choice.

At this point in my Second Stage contribution, I will talk about some of those issues. I recognise the advances that have been made and the measures the Minister has taken over the course of the last five years in a range of areas. I recognise and accept that the abolition of inpatient hospital charges, for example, was a positive step forward and that the expansion of GP care and the provision of more free GP visit cards was important as well. However, I hope the Minister will accept that we are still a long way away from having a single-tier public health service that is free at the point of delivery - the health service that was promised in Sláintecare. There have not been any major changes to medical cards in a number of years. I hope that whoever is in and leading the next Government will see major reforms in that area. There are many people on low and medium incomes who should have access to and availability of a full medical card. We also have to do much more to reduce the cost of medicines, particularly prescription medicines. All of those must collectively and individually form part of what political parties will offer during the course of the election campaign for who might be in government next. We have to continue to take big, bold steps to reduce the cost of healthcare. That will in part reduce the pressure and reliance on people to take out private health insurance.

The biggest game-changer, if I were to look for one, and the biggest benefit of private health insurance at the moment is access to day-case elective planned procedures. That is probably the biggest advantage. If you have an emergency, you are going to more than likely end up in a public hospital if it is a trauma or a heart attack. That is most likely where you will end up getting treated. The benefit for private health insurance does not exist there. Of course the State provides all those very costly specialist services, as it should. Many people have private health insurance because they feel they have no option or choice. The big benefit of private health insurance, as I see it as someone who does not have it, is in diagnostics, scopes, scans and planned procedures. There is a lot of profit in it because patients are in and out and done. That is where the scale and profit is. That is where the money is. That is why it is so important that the elective-only hospitals are built.

If we want to talk about reform with a big "R" in healthcare, it involves separating scheduled care from unscheduled care. In the public elective-only hospitals we are planning to build, people can get day procedures and planned procedures done very quickly and rapidly. This means they do not have to wait many years, in some cases, for access to very basic care. I have given the example a number of times, and I will repeat it again because it haunts me to this day, of when my own mam got sick with cancer. I brought her to a hospital in Waterford. I knew she was sick for some time. I knew there was something wrong. My family had an instinct, although I do not know if she did at that point. However, I brought her to the public hospital. She was brought to the emergency department, got a quick examination and was told that she would have to go on a waiting list for a scan that could take six months, a year or longer. A physician I know - a consultant working in the emergency department - pulled me to one side, said it would cost about €600 or whatever it was to get the scope in what is now UPMC Whitfield Hospital, and advised me to go and get it done. We took that advice and she got access within a week because the money was there. She was able to get the scan, and she was diagnosed with cancer. Unfortunately, she had to battle for a year and did not come through it. This is my point, however: why did she have to go to the private clinic? She got the care more quickly there, having been told she could be waiting six months or a year. We know rapid access to diagnostics is one of the reasons people take out private health insurance. Getting day case procedures is one of the reasons. My point is that if we really want to transform healthcare and have a single-tier public health service, which we all signed up to under Sláintecare, we have to deliver on those reforms.

While I am sure the Minister will defend his position robustly, I have to point out that we have not made the progress we should have made with the elective-only hospitals. I know that sites have been identified. In Dublin, maybe we are a bit further down the road than we were when we discussed this three or six months ago. It must be a top priority for the next Government. These areas are ones in which we can reduce the dependency on private health insurance. I do not want to be in a situation where we are coming here every year discussing a Bill like this, which I support because of the fact that so many people have private insurance. In reality, we know many people are struggling with the costs of childcare, fuel prices, groceries, the cost of living, paying a mortgage or rent and all those issues and on top of all of that, they have to take out private health insurance, as they see it. They do not believe they have any choice because they want to protect their families.

We also know, and it is a product of the failure in the healthcare system as well, that children who have a disability are paying for private assessments of need. Parents of children with disabilities are paying for therapies privately because they cannot get access to those services publicly through the HSE because of failures in these areas. Even though we are spending a lot of money in healthcare - €24 billion this year - people look at all of that and it does not matter to them whether it is €10 billion, €20 billion or €50 billion.

What matters to them is whether they can get access to healthcare quickly and whether their child with a disability is getting the assessment of need that child deserves or getting the therapies that he or she needs. They want to know why their loved one is on a hospital trolley. They are asking why there are nearly 1 million people on some form of health waiting list? I heard some misinformation on waiting list in the course of the Dáil proceedings today, by the way, which I am happy to say was misinformation because long wait times have come down but we still have 800,000 people on some form of acute hospital waiting list when one looks at all of them. We also have far too many on community waiting lists, we have diagnostic waiting lists and there are hidden waiting lists in other areas as well. The point is there are far too many. Although, rightly, there was a concentration on reducing the number of long waiters, which I have fully accepted, I hope the Minister would also accept that, while some progress has been made, we have a long way to go.

It was done differently in Britain when, through an Act of Parliament, the NHS was brought into being and there was a single-tier health service. That is not without its challenges now. As we look at finishing the job in terms of Sláintecare, there are lots of examples around the world that we can look at, such as the Nordic countries, for example. We have to look at every country and look at the best and the worst of all the systems as we continue to make the progress we want to make.

I want to get to a point where we have a health system that is a single tier. There will always be private health insurance and private healthcare but there should be less of it, less profit in healthcare and more opportunities for people to access public healthcare in a timely fashion. Whether it is a child with scoliosis, a child with disabilities, an older person looking for home care or somebody who has a mental health challenge and cannot get access to mental health services when he or she needs it, all of these are areas where we need still more investment, more reform and more changes.

I will be supporting this Bill. As I said, I will speak to a number of amendments. Obviously, on Committee Stage, we will deal with the other issues that the Minister is bringing in as well, including the public scheme for HRT which, of course, I support. It will be massively important for women and I commend the Minister for bringing that in. It is really important.

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