David Cullinane (Waterford, Sinn Fein)

What we were looking for was a report that would look at a number of things. If the Minister looks at what the amendment actually calls for, it is for the preparation and submission of a report from the Minister for Health, having undertaken a review of the current profit rates of health insurance providers. The Minister will have noticed over the past year that most of the private providers have increased their premiums. One of the reasons they give, similar to what we are seeing in the public health service, is high health inflation. When I asked this at the Oireachtas health committee I think I was told that it had come down to about 3%. Previously, maybe two years ago, when we were having discussions about existing levels of service and what additional funding would be needed for the health service to stand still, we were told health inflation was running as high as 10%.

Notwithstanding that, however, and even with inflation having come down, unfortunately premiums have gone up and up. In some cases, providers have put up costs twice. It is important then for consumers to know that the Oireachtas and the Minister are constantly looking at the profits private health insurance companies are making and the trend of providers' profits. What are the trends from 2019 onwards? Are they making more? Why are they making more? Is it because they have more customers or is it because they are charging more and making more money? All of that, in my view, is in the best interests of consumers, as is, as I said, looking at the rate of health inflation. It seems to me it is difficult to estimate and it fluctuates. I am not even sure if there is a perfect science in relation to health inflation. Certainly, it seemed to be extremely high a number of years ago. It seems to have come down. We were told previously that was down to the costs of, for example, equipment, consumables in hospitals and even food and that those costs were driving up health inflation, while pay was less of an issue. As I said, I support an annual analysis of the ongoing impact of the removal of private practice from public hospitals.

I will not delay the passage of the Bill; I just want to make this point. I raised it very forcefully yesterday on Second Stage. We are talking about private health insurance and a lot of money being made by private health insurance providers. I am not against private health insurance. I personally do not have it but I am not against it. If somebody wants to take out private health insurance, good luck to them. It is a benefit to many people if they feel they cannot depend on the public system, and there are advantages to it, particularly in relation to planned procedures, elective procedures. I see them myself in my own circle of family and friends. They can get day case procedures done much more quickly if they have private health insurance and go to a private hospital. That is all the more reason, from my perspective, for us to prioritise the four public elective hospitals, complementing the surgical hubs. I have described this before as reform with a big "R" in the health service. If we really want to reform waiting lists and want to transition to a single-tier health service, with people not having to take out private health insurance because they are fearful or are looking for rapid access, these four elective hospitals, providing on scale and at speed, rapidly, within weeks, elective procedures, would make such a difference. I raised with the Minister, also at the Oireachtas health committee, issues coming to me almost daily in my constituency, including hip, cataract and hernia procedures. Sometimes people wait over a year. One good friend of mine has been waiting 18 months for a hernia operation. Another friend of mine has been waiting over 18 months for treatment for cataracts. Fortunately, he has now got on to the National Treatment Purchase Fund, NTPF, and I think he will be seen in the next few weeks. That is great, but we should have these elective hospitals doing these treatments at scale. I know we have had discussions about how long they will take and whether the capital funding is there. I believe that is one of the biggest reforms we can make. If we do make it, fewer people will feel the need to take out private health insurance if they believe they can get access to these types of procedures quickly and rapidly.

I can accept or understand why the Minister is not accepting the amendment from her perspective. Irrespective of the amendment, it is important to us. She is right that the Oireachtas health committee is a place where we can do this and constantly look at these issues in detail. We look at costs in relation to public health, how much we are spending in health and how we can get more efficiencies in healthcare. We could talk all day about how we can achieve efficiencies but we also have to look at the private health insurance market, which is a big market. People are paying a lot of money and they want to know they are getting value for money and not being ripped off. When they see increases in premiums, they want to understand fully why that is happening. That was the purpose of the amendment.

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