Billy Kelleher (Cork North Central, Fianna Fail)
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I wish to outline the alarming increase in the cost of private health insurance. Many people speak about "middle Ireland" and how hard-pressed it is. An illustration of how serious the situation is for many families is that people are now deciding whether they should fill the oil tank or continue with health cover. We have seen an alarming increase in the cost of premium payments for private health insurance. The cost of VHI cover for a family with two children has increased to €2,300 per year. There has been an alarming increase in recent years. Since 2009, health premia have increased by a minimum of 100% and, in some cases, by as much as 130%.

Year on year there have been exceptional increases.

We have to address this issue. These people are lightening the State's burden in the provision of health care. They have contributed through the general Exchequer in taxation and through sacrifice and effort have taken out private health insurance to provide cover for themselves and their families. They are being crucified. If we allow this to continue, the advances the Government is trying to make in regard to universal health insurance will unravel before the Minister's eyes. People simply cannot afford to continue to pay these alarming increases. Consultants' pay is one issue on which the Government has been faffing about for a long time. There is also the issue of charging private patients for public beds, which has placed and will continue to place a burden on premium holders throughout the country. The €125 million the insurers decided to give upfront in order to dig the Minister for Health out of a hole in regard to his budget deficit is now coming back to haunt us. It is not the health insurers who are paying upfront; rather, it is premium holders throughout the country. That is not good enough.

Mattie McGrath (Tipperary South, Independent)
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I thank the Ceann Comhairle for giving me the opportunity, along with Deputy Kelleher, to raise this issue. Deputy Kelleher has made a pristine case. The last speaker, a Government colleague of the Minister of State, was critical of the answers given to the House by the HSE and the Department of Health. That much was stated clearly on the record of the House. We do not get proper answers or proper governance from the Department of Health. The Minister, Deputy Reilly, should be present today to take these questions and should not send in a Minister of State who does not have responsibility for the matter. I welcome the Minister of State's presence, however, and I wish her well in her post.

This is out of control. I cannot believe the increase in charges, which have gone up by 120% to 130% in the past three years. Increases of 100% have been imposed by the VHI and other organisations. I note that there will be people attending the Joint Committee on Health and Children tomorrow to give answers, but what answers can they give us? It is pure sabotage and hijacking. The Minister has no credibility on this issue because he is one of those who negotiated rates for GPs. He cannot play two sides of the road, although he tries to do so all the time. What will happen is that people will die on the road. More than 2 million people have some kind of cover but this gives them less and less for more and more money. They cannot afford it. Ordinary middle-income families and even the reasonably well-paid cannot afford the cover. This puts pressure on public hospitals, with consequent queues and waiting lists, as was discussed in the previous topic in the debate.

We must change this. We cannot allow the companies to charge these exorbitant rates. I once stayed in a private hospital in Cork and had to travel about 600 yards in an ambulance. Deputy Kelleher would know the place well. I could have walked there but not back, as I was under anaesthetic. The ambulance charge was €600 to bring me less than half a mile - a rip-off. Rip-off Ireland is alive and well and this situation cannot continue. Ordinary people cannot get access to beds or anything else while this rip-off is going on. Consultants are getting too much pay and are using public beds and public equipment to treat their patients privately. The racket has to end. I thought the Minister would do something about this, but I reiterate that he has no credibility with regard to one of the groups concerned. He is not the man to do it. I hope some of his other colleagues will step up to the plate.

Jan O'Sullivan (Limerick City, Labour)
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I am taking this matter on behalf of my colleague, the Minister for Health, Deputy James Reilly, who unfortunately cannot attend. This issue was around for years during the time of the previous Government and very little was done about it.

There has been recent speculation regarding possible increases in private health insurance premiums. As the Deputies are aware, the Minister for Health has no role to play in the commercial decisions of any health insurer with regard to planned increases in the costs of its insurance products. I am aware that health insurance is becoming harder to afford, particularly for older people, as insurers increasingly tailor their insurance plans towards younger and healthier customers. The Government is strongly committed to protecting community rating, whereby older and less healthy customers pay the same amount for the same cover as younger and healthier people.

In January of this year, my colleague the Minister for Health, Deputy Reilly, announced changes which will help to make private health insurance more affordable for older people. Since 1 January 2012 there has been an enhanced age-related income tax credit for each insured person aged 60 years or over. Community rating of health insurance is at the very heart of our system and will remain so under universal health insurance. Risk equalisation protects community rating by spreading the burden of health care costs between the young and the old, the healthy and the less healthy. The Minister is unhappy about the trend towards segmentation in the market and has raised the issue directly with the insurers. He has consistently raised the issue of costs with health insurers and is determined to address costs in the sector in the interests of consumers.

The programme for Government contains a commitment to establish a permanent scheme of risk equalisation. This is a key requirement and is designed to keep health insurance affordable for older persons and to maintain the stability of the market. The Government agreed to the Minister's proposals for an improved risk equalisation scheme and published the Health Insurance (Amendment) Bill 2012 on 18 October. The new Bill will introduce a permanent risk equalisation scheme, RES, effective from 1 January 2013. There are some important differences and improvements compared to the current interim scheme which the RES 2013 replaces. In order to deal with issues of affordability, there will be two levels of cover: advanced cover, to which higher risk equalisation credits and higher stamp duty will apply, for public and private hospital plans; and non-advanced cover, to which lower risk equalisation credits and lower stamp duty will apply, for public-hospital-only plans. In addition, the new RES will allow for a greater number of risk factors, including age, gender and type of cover as well as measures of health status. A risk equalisation credit based on bed usage is proposed as a measure of health status.

In respect of access to public hospitals, as referred to by Deputy McGrath, the work of the special delivery unit, SDU, continues to focus on improving waiting times for access to both scheduled and unscheduled treatments and to maximise the capacity of existing facilities to manage patient flow. Since July 2011, when the SDU was set up, the number of people having to wait more than 12 months for treatment has fallen by 85% and the number having to wait more than nine months has fallen by 91.1%. The overall waiting list has reduced by 16%.

The Government's clear objective is for the health insurance market to remain as competitive and affordable as possible as we move towards a new system of universal health insurance. The Minister, Deputy Reilly, will continue to explore any available measures to limit the costs related to health insurance.

Billy Kelleher (Cork North Central, Fianna Fail)
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I welcome the reply by the Minister of State, but the difficulty is that people and families throughout the country simply cannot afford to continue to pay the increases. There have been alarming increases in the private health insurance market in recent years. While we welcome competition and the opening up of the market, something must done to address the issue of spiralling increases in the cost of health care and health insurance in this country, including dealing with consultant hospital contracts. In addition, the decision to charge full costs for private patients in public beds is increasing the cost of health insurance. That is clearly a policy decision. I ask the Minister of State to convey to the Minister the deep concern of many people about the escalating cost of private health cover for families.

Mattie McGrath (Tipperary South, Independent)
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I too am very disappointed in the reply. I know the Minister of State was only reading out on behalf of the Minister what she received from the Department. The Government is supposed to have agreed to the Minister's proposals for an improved risk equalisation scheme, but we are not getting this. We are being charged more and more for health insurance. I have a large family and our insurance continues to rise. That is my situation and I can hardly continue with it. One goes for a procedure in a hospital and finds there is less and less cover. Pure rip-off Ireland is alive and well.

I accept this did not all happen under the tenure of the present Minister during the past 18 months, but costs have increased three times since he came to power. The insurers must be taken on, called aside and told to stop. We cannot keep crucifying the ordinary people and trying to draw blood from a stone. There is no blood in the stone - people do not have the money. The increases attack the efforts that have been made to cut waiting lists, procedure times and everything else in hospitals. Too much is being taken out in this regard. Consultants are using public facilities and we are being screwed, although I hate to use that word. It is an awful situation and it is untenable.

I look forward to meeting the representatives tomorrow at the committee, but the Government must act. It is in charge and must cry halt to rip-off Ireland.

Jan O'Sullivan (Limerick City, Labour)
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It is certainly not today or yesterday that these increases happened.

Mattie McGrath (Tipperary South, Independent)
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I accept that.

Jan O'Sullivan (Limerick City, Labour)
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In spite of the money that was in the country, there was no reform of the health service. The universal system to which the current Government is committed will address inefficiencies and extra costs in the health service and will deliver improvements for patients. A risk equalisation scheme is to be introduced by the Minister under the legislation he has introduced. The scheme in place under the former Government was struck down a long time before that Government fell and no permanent scheme was put in its place. What we are getting now is reform and new legislation.

I hope Deputy Billy Kelleher is not suggesting health insurers should not pay what is rightfully owed in the context of the use of private beds in public hospitals. One would expect that they would pay in respect of private patients in public hospitals.

A great deal of reform is taking place under the Minister. That reform will continue and assist in delivering more efficient and effective care for patients and better value for money.