Martin Daly (Roscommon-Galway, Fianna Fail)

I want to reflect on the Bill, which I fully support it. It is vital that we maintain community rating through a risk equalisation scheme and the stamp duty paid. I also want to ask and reflect on why 46% of people feel they must insure in this country. As a practising GP who has been involved in medical politics for many years, it is my view that one third of people cannot afford insurance and are covered fully by the public system. One third of people may always insure, no matter what public system we have in place, and I think that experience is borne out in other countries. One third of people feel that if they had a choice and the capacity was there in the public health service, they would not insure and they are certainly hard pressed to insure themselves.

They do so because they do not have confidence in the public health system to deliver healthcare for them when and where they need it. That is what we need to reflect on.

We also need to reflect on Sláintecare. I am a publicly funded doctor. I have worked mainly in public practice with the medical card system. I believe in a public health service but I believe we need to reflect on Sláintecare. The capacity is not there. It is difficult to see how we will create a capacity for the 46% of the population who feel they must insure themselves. Many sons and daughters fund private health insurance for their elderly parents because their parents cannot afford it and want access.

I am also concerned about private health insurance companies. There are in or around 336 plans and, to me, that represents a lack of transparency. I have had multiple patients come in to me to find out at critical times of illness that they do not have insurance cover for particular procedures in private hospitals and it was not that clear to them when their policies were being sold. I have sent them to the Health Insurance Authority and advised them to seek help there. However, that there are 336 plans means to me that people are being confused by what they are being offered and it does not serve the consumer well.

On the public side, productivity remains an issue, and one of the issues around productivity is that we can keep throwing money at an archaic structural organisation like the HSE but unless we achieve digitalisation and really improve productivity in our hospitals and our clinics, we will not get value for money. In fairness to the Minister, Deputy Carroll MacNeill, and as the Minister of State has said, there has been a significant increase in public funding, but without the commensurate increase in productivity.

I want to reflect briefly, because I am running out of time, and I do appreciate this time, that the major health insurance companies are now investing fortunes in advertising and in these big centres in urban areas offering all sorts of services. That is fine, but there is no risk equalisation for the rural person who is living in a county like Roscommon or east Galway, where there is no access to private beds. Are they subsidising access for people who are living in urban areas to these super-duper 365-day centres run by various health insurers?

Finally, people say private health insurers are so efficient. The public health service provides the bulk of healthcare in this country. Let us get that straight. If you have a stroke in this country in the morning, there is no private facility that will admit you to hospital, and the same applies for hospice care. People need to remember that. They need to remember that our public hospital service underpins everything that happens in this State and it is exceedingly good value for money for what we get.

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