Róisín Shortall (Dublin North West, Social Democrats) | Oireachtas source

This is the annual practice of committing to the provisions of this legislation relating to the private health insurance market to provide for community rating and risk equalisation. It is a technical measure. In the context of a private health insurance market, it makes sense not to have cherry-picking by some of the newer entrants into the market or any kind of marketing to attract younger entrants where the demand for services would be lesser than for older existing policyholders. For that reason, it makes absolute sense. This is the technicality that we go through every year at this time. I have no difficulty with the provisions of this legislation insofar as they go but I will make a few points about this Bill.

Some 47% of people have private health insurance and the contribution that is made by those policyholders is valued at €3.2 billion. When one considers the total health spend this year will be close to €26 billion and nearly half the population is covered by private health insurance, the private health insurance premiums only make up a tiny fraction of the overall spend on health. It used be 15%; it is less now. It is a very small contribution, given that nearly half the population has private health insurance.

Private health insurance is very expensive. Last year, the average premium was €1,600. When one considers the number of people in the country who are contributing an average of €1,600 to private health insurance, yet the spend is so much more than that, the point is that the taxpayer is paying for the vast bulk of healthcare services to private and public patients. In recent years, and through Sláintecare, there has been an effort to untangle that. In many ways, because of the small contribution private health insurance makes to the overall health spend, that was considered in quite a bit of detail by the Committee on the Future of Healthcare. The committee looked at different funding models for a properly functioning Irish healthcare system and the conclusion reached by everybody on the committee was that the vast bulk of healthcare is being paid for through taxation, so why would one change from that system?

For that reason, we recommended a national health insurance type model, where tax receipts would fund the full health service. It is just important to bear that in mind. We have to ask where all this money is going. Is there not massive cross-subsidisation from the public purse to private patients? That is the reality of what is happening. In many ways the State is not getting very good value for the private health insurance providers.

Things are hopefully changing as a result of Sláintecare. A fair deal of progress is being made and has been made in recent years even though it had an exceptionally slow start in terms of implementation. Of course, we still have a very long way to go. Sláintecare is the cross-party agreed policy for all parties and independents here in the Dáil. It is disappointing that seven years in there is still such a long way to go. I call on all parties facing into the upcoming election to commit to fully funding Sláintecare within the term of the next Government, not merely paying lip service to that, and that there would be a commitment to pre-committing the necessary funding each year. Every year in the budget, money is pre-committed for the national development plan or the public pay agreement. It should also be pre-committed for the full implementation of Sláintecare. Parties should consider doing that. It would be an important thing in the interests of the State and all our citizens if we did this. It has the potential to be transformational in terms of people's lives because of the speedy access to healthcare that could be possible, resulting in much better quality of life and indeed saving lives over the coming years. We are so out of line with what is happening in the rest of Europe. In the main, citizens in European countries take it as a given that they have access to a universal healthcare system. There are different ways of funding it but it is a given. The idea of paying to see a GP or paying through the nose to see a consultant is just unheard of in most other European countries. We have a long way to go.

I want to talk about a number of those areas where progress is slow. I will recognise the progress that has been made but still we have a distance to go in removing cost as a barrier to access to healthcare. We have seen improvements over the last few budgets but there is still a lot to be done in that regard. An awful lot of people have to pay the full cost of €60 or €65 to see a GP. As I said already, there is then the significant cost of accessing a consultant. There is also the cost of medicines, of course. That needs a two-pronged approach in my view. We need to be negotiating with the pharmaceutical industry in a thorough and robust way, which we have not been doing. The cost of medicines as a percentage of the spend on health is far too high in this country and much higher than in the UK, for example. Considering the strength of the pharmaceutical industry here, the very good deal they get tax-wise and the very good operations they have thanks to the Irish education system, it is just not good enough that they are screwing us over in terms of the cost of medicines. I have often thought that the approach by the Department of Health is not a very clever one when it comes to negotiating price with the pharmaceutical industry. In commercial terms, these are sharks that come in. There are billions of euro at stake here, yet we do not have professional negotiators negotiating decent prices. That needs to be dealt with.

On re-orienting the health service to the community, we are still far too hospital-centric. In order to re-orientate fully we have to have adequate capacity at primary care level. That capacity just is not there. We are on the way but it is certainly not there yet. We need to take new approaches. For example, there is a serious shortage of GPs. While we can train more, the reality is that more of them will go abroad and work in other systems that function better than ours. I will say again to you, Minister, you need to consider the proposal to have salaried GPs. There are lots of GPs who want to work in the Irish healthcare system. They do not want to be business people. They want good work-life balance. That certainly will not be achieved under the present contract. The way to achieve it is by having salaried GPs or different partnerships. I have been talking to the Minister about a charity, GPCareForAll, which looks like being lost now through inaction on the part of the Department of Finance.

I also want to talk very briefly about the importance of the legislative proposals in Sláintecare. It recommends legislation on a number of different areas. The first is on the need for a legal right to healthcare. Unlike social welfare, for example, there is no legal right to healthcare. We have this daft thing of eligibility. You are eligible if the service is there but it is tough if the service is not there. We need to legislate for a legal right to healthcare. We also need to legislate for accountability from ministerial level down to the regions at clinical and administrative level. That is a key part of establishing accountability in the culture or changing the culture to establish accountability across the board in respect of healthcare.

I repeat my concern about the drift in the health service in respect of over-outsourcing of so many different services, which is essentially the privatisation and financialisation of the health service. The Minister needs to stop that.

See this speech in context