David Cullinane (Waterford, Sinn Fein)
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I move amendment No. 1:

In page 3, between lines 17 and 18, to insert the following:

“Report on profits, rising costs, and potential impact of removal of private practice from public hospitals

3. The Principal Act is amended by the insertion of the following section after section 33: “Report on profits, rising costs, and potential impact of removal of private care from public hospitals

33A. (1) The Authority shall, before and by 31 July 2026, prepare and submit a report to the Minister for Health having—

(a) undertaken a review of—

(i) the current rates of profit health insurance providers,

(ii) the trend of profits of providers since 2019 to date, and

(iii) the rate of health inflation from 2019 to 2025 and the corresponding changes in the costs of health insurance, and

(b) conducted an analysis of the potential impact of the removal of private practice from public hospitals on the cost of health insurance.

(2) The Minister shall, as soon as may be after the receipt by them of a report under subsection (1), cause copies to be laid before each House of the Oireachtas.

(3) The Minister shall, on foot of this report, bring forward proposals for off-setting inasmuch as possible the rising costs for consumers against profits on the basis of the analysis conducted by the Authority.”.”.

We have tabled an amendment to require the Health Insurance Authority to prepare a report on raising insurance costs, industry profits and the potential impact of the removal of private healthcare from public hospitals on insurance premiums.

The HIA publishes an annual report and various other reports and is constantly monitoring the industry and the market. The removal of private practice from public hospitals is, from my perspective, a positive move, and we discussed that at length yesterday on Second Stage, but it may have consequences for premiums. The purpose of the amendment, however, is to ensure the Oireachtas is prepared for any potential consequences for consumers and ready to legislate to offset this against industry profits insofar as possible and if necessary.

Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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I thank the Deputy for the proposed amendment. The issue of reducing private income in public hospitals is one on which he and I agree. Indeed, we discussed it during the recent debate on the Estimates at the Oireachtas select committee. It is particularly pertinent given that this is the year it really kicks in. We have reached a critical mass of consultants on the public-only consultant contract and this is the year we expect to see it in our figures. We had a good discussion about that in the context of the Estimates. I do not expect this to be a recurring issue of the same magnitude. It is an issue this year and that is essentially banked into our figures for the future. It is very important we understand that, keep that on track and keep the measure to remove private activity from public hospitals insofar as possible. We have more work to do on that yet, and I look forward to working on that with the Deputy.

As regards the specifics of this legislation, this year's Health Insurance (Amendment) Bill does not directly relate to that. It is about risk equalisation credits and stamp duty levies for health insurance policies in Ireland. Its goal, the purpose of the Bill, is to adjust the risk equalisation scheme to reflect the yearly changes in the market. It is mostly a technical Bill and an annual Bill on that basis, keeping the scheme running smoothly. The Deputy's amendment deals with a different matter, which is very important but which is not the subject of this Bill. On that basis, I cannot accept the amendment, but we should be engaged on this subject on an ongoing basis at the committee. I refer to the impact of removing private activity from public hospitals, making sure the public funding is used for public provision but also understanding better how, with real delineation between public and private, we can better utilise private services in tandem with State services and how we understand the health market as a whole.

I cannot accept the amendment on this occasion, but the broader issue the Deputy raises is extremely important and will be the subject of our debate anyway.

David Cullinane (Waterford, Sinn Fein)
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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.

John McGuinness (Carlow-Kilkenny, Fianna Fail)
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The Bill will be sent to the Seanad.