Niall Collins (Limerick, Fianna Fail)
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Question 8: To ask the Minister for Health the model of health care on which universal health insurance is likely to be based; the other models being examined; and if he will make a statement on the matter. [1169/12]

Billy Kelleher (Cork North Central, Fianna Fail)
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Question 17: To ask the Minister for Health the provisional estimates for the total cost of universal health insurance; and if he will make a statement on the matter. [1164/12]

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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Question 42: To ask the Minister for Health when the promised White Paper on Funding Universal Health Insurance will be published; and if he will make a statement on the matter. [1316/12]

Micheál Martin (Cork South Central, Fianna Fail)
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Question 958: To ask the Minister for Health if he has attended meetings at which the universal health insurance model and hospital insurance fund was discussed; the progress made on same; and if he will make a statement on the matter. [32720/11]

James Reilly (Dublin North, Fine Gael)
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I propose to take Questions Nos. 8, 17, 42 and 958 together.

The Government is committed to fundamental reform of the health system. This will see the delivery of a single-tier health service, supported by universal health insurance, which will ensure equal access to care based on need, not income. The universal health insurance system will be based on the principle of social solidarity. Every citizen will have a choice of insurer and equal access to a comprehensive range of curative services. A new insurance fund will subsidise or pay insurance premiums for those who qualify for a subsidy.

Key features of the reform programme which will underpin the introduction of universal health insurance include the strengthening of primary care services to deliver universal primary care with the removal of cost as a barrier to access for patients. It is a paradox of the current system that that which is the most efficient and cost effective, that is, primary care, has a cost associated with it and a barrier and that which is most expensive, that is, hospital care, does not. The work of the special delivery unit will continue in tackling waiting times - this relates to both scheduled and unscheduled care. The key features include the introduction of a more transparent and efficient "money follows the patient" funding mechanism for hospitals, and the introduction of a purchaser-provider split, whereby hospitals will be established as independent, not-for-profit trusts.

In addition, I recently announced significant changes in the governance of the Health Service Executive, under which the current board-chief executive structure will be replaced with a directorate or transitional governance structure. This new directorate structure will facilitate greater transparency, accountability and efficiency, and is a key component in the move to universal health insurance.

The reform programme is a complex and major undertaking that requires careful planning and sequencing. Detailed consideration must be given to the optimal structures for delivery of services and the critical inter-relationships between services, as well as best practice in health care reform. My officials and I have attended numerous meetings with interested parties at which various aspects of the reform programme have been discussed. These included a study visit by my officials to the Netherlands in June last year to examine the Dutch health insurance model. In addition, my Department organised a seminar on universal health insurance which was attended by experts from the Dutch Health Ministry, the World Health Organization and the European Observatory on Health Systems and Policies. Such contact with relevant bodies, both at national and international level, is vital to enhancing our knowledge and informing policy. I see it as imperative that we continue to engage with interested parties and gain from the experiences of other countries in this area. Ultimately, however, the Government's reform proposals will be designed to meet the needs of the Irish people and system and ensure the best outcome for Irish patients.

In order to assist in developing detailed and costed implementation proposals for universal health insurance and help drive the implementation of various elements of the reform programme, the Government has approved the establishment of, and the terms of reference for, an implementation group on universal health insurance. I am finalising details of the implementation group, including its composition, which I will announce shortly.

The implementation group will have responsibility for assisting the Department in preparing a White Paper on Financing Universal Health Insurance which will outline the estimated costs and financing mechanisms associated with the introduction of universal health insurance. The White Paper will be published towards the end of the year. However, it must be borne in mind that the precise cost of universal health insurance will depend, to a large degree, on the implementation of various reform measures as outlined. This highlights the importance of driving performance improvement and progress on reform across the health system as quickly as possible.

Billy Kelleher (Cork North Central, Fianna Fail)
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This is an extremely important issue and it must be discussed. The Minister referred to the publication of a White Paper at the end of this year. At that stage, he will have been in office for almost two years. He has made commitments in respect of health insurance and he referred to a long timeframe and a lead-in period. In the meantime, we are faced with a crisis of major proportions in the private health insurance industry. Many people are giving up their private health insurance because they cannot afford to pay their premiums. In addition, there is the question of the ruling of the European Court of Justice in the context of the VHI requiring a capital injection of €220 million. Then, there are the problems associated with Quinn Healthcare. While the Minister is discussing his grand designs, people cannot afford to pay for private health insurance and the Government may find itself in a hugely difficult position if it is obliged to provide VHI with a major injection of cash to bring it into line with other health insurers.

The Minister has a major problem but he does not appear to be addressing it. He is discussing something that will occur way down the road. In the interim, we are facing into a crisis of major proportions in the context of private health insurance. It is fine to discuss and be fascinated by the Dutch model. However, and regardless of whether Deputy Buttimer approves of our doing so, we must discuss bread-and-butter issues such as that relating to families not being in a position to afford private health insurance. Last year, the Minister referred to the increases that were introduced as being appalling and horrendous. The position in this regard has become even worse in recent months.

James Reilly (Dublin North, Fine Gael)
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What would have been the nature of the increases if the Government of which his party was a part had introduced a risk equalisation scheme rather than merely bringing forward a levy so that it might continue to kick the can down the road?

Billy Kelleher (Cork North Central, Fianna Fail)
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There were many reasons for that, including legal ones.

James Reilly (Dublin North, Fine Gael)
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As I am sure he is aware, the question is rhetorical.

We are engaged with Europe in respect of matters relating to the VHI, the need for its position to be put in order by the Central Bank of Ireland and the exigencies and strictures that obtain. We will not allow a scenario to evolve whereby the urgent will continually displace the important. We have a short-term strategy to allow us to deal with the immediate situations we face. Hence, the establishment of the SDU, the development of the clinical programmes and our discussions at Cabinet on the current position of the VHI and in respect of the market, which must be regulated and regularised. One thing that will prevent other insurers entering that market is uncertainty. That is why it is awaiting the publication of the risk equalisation scheme, on which the Cabinet has signed off and which will emerge shortly. That scheme will increase competition and will lead to prices being driven down.

We also have medium and long-term strategies. Our long-term strategy is to introduce universal health insurance as quickly as possible. Our plan for the medium term is to do what we always said we would, namely, make the best use of what is available to us. That is what we are doing. We are obtaining efficiencies through the clinical programmes. We are also bringing in the money-follows-the-patient model so that there will be transparency and that it will no longer be the case that hundreds of millions of euro will be dispersed into different parts of the system without our knowing about it. We will introduce universal health insurance so that every man, woman and child, regardless of income, will be treated on the basis of need and as equals.

Michael Healy-Rae (Kerry South, Independent)
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Deputy Buttimer is very quiet today.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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The final line of the Minister's reply comes directly from Sinn Féin policy. The only difference is that the Government intends to introduce an insurance-based model as opposed to universal entitlement to health care. Before the general election, the Minister promised a detailed breakdown of Fine Gael's proposed insurance-based model. However, that information has not been forthcoming. Following the Minister's initial reply to these questions, we know nothing more about what is proposed. Will the Government's model be based on the State as insurer or will the existing insurance companies form part of what is intended? Is the Minister in a position to indicate what might be the actual contribution per citizen or what the State might be obliged to contribute if it is intended that it pick up the tab for those who cannot afford to make payments themselves? Can he comment on any or all of those critical matters? When will we see the real detail of what is proposed? I welcome the Minister's clarification to the effect that the White Paper will be produced earlier than he indicated in the House not that many weeks ago.

James Reilly (Dublin North, Fine Gael)
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There are many similarities and differences between ourselves and Sinn Féin. One of the differences is that Fine Gael and Labour will deliver because they are in government. We are in a position to do what I have outlined and we will do it. We do not aspire to do what is proposed, we intend to deliver on our promise.

The Deputy asked a number of extremely reasonable questions in respect of the shape of the proposed universal health insurance system, the likely level of premia, the way matters will be organised, and so on. It would be wrong of me to pre-empt or second guess the implementation group on universal health insurance which will study this matter and produce well thought out recommendations on how we might proceed. What is proposed is a major step for health reform here and there are many who feel it will not be possible to deliver what is envisaged, particularly at a time of such economic difficulty. We will deliver but it will be necessary to engage in careful planning, thought and implementation in respect of the proposed system. Approaching this matter in the way in which we previously stated we would - namely, by fixing what is already in place, obtaining better results in respect of the resources at our disposal and then moving towards a universal health insurance model - offers the best chance of success. Citizens will not be interested in everyone being insured if people are obliged to wait nine months for a colonoscopy.