Tuesday, 15 April 2014
Ceisteanna - Questions (Resumed)
Government Information Service
1. To ask the Taoiseach if his Department has a policy on Government information services sending out reports or press releases on St. Stephen's Day; and if he will make a statement on the matter. [2209/14]
I thank the Taoiseach for his reply. The reason I tabled the question is that a major report on private health insurance was issued by the Government on 26 December last. The one and only reason this was done, of course, was to try to bury it, and it would appear to me that was a clear policy decision. No Government which wants to respond to questions or wants to engage with the public on issues would publish a comprehensive and substantive report on such an important issue on St. Stephen's Day. It seems to be a clear and obvious abuse in itself.
As the Taoiseach knows, people had seen and are seeing massive increases in their insurance premiums, and tens of thousands of people over the last two years have dropped their insurance. Many have done so since the budget, and the Taoiseach will remember the very controversial decision that was taken in the budget two or three months before this report was published. In essence, the report painted a very stark picture of the future for health insurance in this country and essentially suggested it was coming very close to a tipping point in terms of its sustainability into the future.
Does the Taoiseach think it acceptable behaviour that the Minister should publish such an important report on St. Stephen's Day, knowing full well there would be no public discussion around it and that people would not have the facility or the capacity, given the day that was in it, to have the kind of serious debate the report warranted on its publication? In recent weeks we have had the publication of the universal health insurance document, with all of its lack of detail. It raises more questions than it answers and, again, it states that more legal and policy analysis has to be undertaken on the key issue of the market rate, despite the fact it is a White Paper. There is no detail in that paper as to the cost and pricing package that people will have to endure.
Given the Government's track record on health, and that of the Minister in particular, it seems to me the whole agenda, from the publication of that report on St. Stephen's Day, has been to avoid public debate on these issues and to delay substantive and penetrative debate where we get real answers. In particular, the publication of that report on St. Stephen's Day is an illustration of how far this Government goes to talk itself up when it wants to, but also to hide the unpalatable when it wants to. Publishing a major report on St. Stephen's Day was a new milestone in this regard. Would the Taoiseach accept that?
I have always tried to be fair here when I am dealing with the Government. Without being at all patronising, I think there are many challenges facing the Government and issues after issues after issues. However, the Taoiseach did promise a new way of doing business, he promised transparency, he promised clarity and he promised a democratic revolution. This report contained 32 recommendations. It is a very important issue for many hundreds of citizens who have private health insurance, which the Minister has acknowledged. Why publish it on St. Stephen's Day, when there is a minimum of media coverage and reporting and, in any case, who is listening to the news on St. Stephen's Day? It is a tactic used by other Governments to bury unpopular news in the middle of or on the eve of a holiday period.
This is a report which, I am sure the Taoiseach would acknowledge, requires the maximum distribution and the maximum information. Information is power; it is about empowering citizens. Therefore, not to give the people that information is to disempower them, which is the exact opposite of the reasoning given by the Taoiseach as to how his Government does its business. Would the Taoiseach not acknowledge it was a mistake to publish this on St. Stephen's Day when, clearly, the whole intention was to bury it as opposed to having debate, discussion and clarity about it?
The question I was asked by Deputy Martin was if the Government has a policy of the Government Information Service sending out reports or press releases on St. Stephen's Day, and if I would make a statement on the matter. I have answered that by saying there are no policy issues in that regard.
This was the report entitled Review of Measures to Reduce Costs in the Private Health Insurance Market 2013. There was an imperative on the Department of Health to publish it before the end of last year, and it let it out on St. Stephen's Day or the day after that. The document is the first of two reports produced by the author, Pat McLoughlin, and the second will be published in 2014. The health insurance companies, to be honest, were very keen for its publication and, far from burying it where it would not be seen, it was expected that the report would be of interest to a lot of people out there and to the media itself.
As the Deputies know, last year Christmas fell in the middle of the week. Consideration was given to the fact a document published on St. Stephen's Day would be of interest and would be the subject of considerable commentary in the post-Christmas period. It was not a case of shoving it off on a shelf where it would not be seen. The report was produced for public discourse and, accordingly, the health insurance companies and the author were alerted to the intention to publish the document on St. Stephen's Day. It was the subject of a number of news reports.
As the Deputies are aware, the phase 1 report which was published contained 32 recommendations under nine different headings. These were about reducing costs of private health insurance and dealt with the following: controlling costs in private health insurance; care settings and use of resources; the age structure of the market; clinical audit and utilisation management; industry approach to private psychiatry; fraud, waste and abuse; chronic disease management; claims processing; and admission and discharge procedures and processes. Most of the recommendations in phase 1 could be implemented on an administrative basis, while a small number, if adopted, would require legislation. There were also a number of key recommendations to drive down costs.
The report, far from being hidden, is absolutely relevant in order to ensure that patients are treated at the lowest possible level consistent with quality, and insurers should use existing information on the appropriate treatment locations for individual procedures.
It recommended that insurers use information of this kind to query cases claimed as an inpatient which might have been carried out on a day basis. In other words, was the right treatment provided? It recommended that insurers provide data to aid a more detailed analysis of the drivers behind the rising costs in the private health insurance. A template to be agreed with the industry is to be completed within the next six weeks to aid further analysis for the phase 2 report. It recommended that in future, the Health Insurance Authority collect these data from insurers regularly to make matters even clearer. It also recommended that the current clinical audit and utilisation arrangements by insurers be assessed in phase 2 to determine whether they are in line with the robustness of international practice; that the extent of clinical audit being carried out by each insurer be independently evaluated in phase 2 of this work; that in line with the plans for implementing money follows the patient, case-based charging be implemented using diagnosis related groups, DRGs, which would mean a fixed, pre-established payment for each case or patient episode, which did not happen previously; that health insurers publicly acknowledge that fraud and malpractice exist and publish data on the extent of moneys recovered from hospitals and consultants; and that the Minister for Health consider introducing measures to encourage younger members into the market and discourage, by means of a financial penalty, people who take out health insurance for the first time after age of 30. This is known as lifetime community rating.
To recap, there is no policy of issuing reports on St. Stephen's Day, Easter Sunday or Easter Monday. This report was due out before the end of the year. It is an important report that contained clear recommendations for driving down costs in everyone's interest. If Christmas Day was at the beginning or end of the week, it might be different. It was in the middle of the week and that decision was taken. I assure the Deputy that there was no intention of hiding the report or deciding we would publish it and no one would read it. The report contains important recommendations that are in the interests of the patient and driving down the costs of private health insurance.
Does the Taoiseach agree there was a policy and this is why this report was published? Will he give instructions to his Ministers not to engage in such a practice again? Most people would say that the reason this report was not published earlier was because of the budget decision on tax relief for health insurance, which hammered health insurance, the flak that would flow from the report, and the degree to which the report confirms the error that was made in the budget decision relating to health insurance and the successive decisions the Government has taken in respect of that issue. That is the point and that is why it was published on St. Stephen's Day. It was published to bury it and ensure it would not embarrass the Government given the earlier decisions it took in the budget.
The question was whether there is a policy on the part of the Government Information Service of publishing documents on St. Stephen's Day. I have answered clearly that there is no such policy. If such a policy existed, Deputy Martin would say we should have published half a dozen reports last week when the President was on a state visit to the United Kingdom. This is a very important report with all these recommendations for reducing costs for patients with private health insurance. The Deputy knows this as a former Minister. These things are pointed out here as being-----
It is out there and it is also online. People can read it. We did not say we published it but no one read it. It is clearly in the interests of patients in respect of private health insurance costs.