Fiona O'Malley (Progressive Democrats)

I welcome the Bill as the beginning of the long-overdue restructuring of the VHI. One of the most pleasant and interesting points of discussion in the Oireachtas Joint Committee on Health and Children during the previous Dáil was the health insurance market and the proposed changes to it. These changes are especially necessary given the competition that exists.

The Minister and I did not necessarily share the same opinion about the commencement of risk equalisation but I accept what has happened. I welcome the start of the process to give a new corporate structure to the VHI. However, as the Minister would accept, it does not go far enough. We need the VHI to be broken up to provide a more level playing field for the health insurance market. Both Senator Feeney and Senator Twomey referred to the sharp practices that exist in the health insurance market and how the consumer is not benefitting from the limited competition that has been introduced.

I fully agree with what Senator Twomey said about transparency. I would be interested to know whether there is some way to oblige companies to provide itemised billing. I recently heard of a person who had stents implanted on an emergency basis. The bill, which was paid through the VHI, amounted to in the region of €1,000. When the consultant recalled the patient to his private rooms to repeat the exact same procedure, the VHI again paid the bill but on this occasion the cost was €6,000. The reason given for the discrepancy was that the VHI had agreed with the clinic in question that this procedure would require a five-day stay. It did not matter that the patient in question only stayed one night because the agreement was in place. That is a disgrace. That kind of sharp practice cannot continue. It would be preferable for patients to be issued with itemised bills and for the VHI to pay for whatever service has been delivered. We should ensure this happens.

The Minister proposes to roll back on the ability of her office to interfere, so to speak, in the VHI. We must provide a framework for a health insurance system that is fair to patients and to those who pay the premia. Reference was made in the York report which was commissioned into the health insurance market in Ireland to the fact that uncertainty regarding the restructuring of the VHI has been a bar to competition. For that reason I welcome the commencement of the process to settle the future structure of the VHI, whatever that may be. The change cannot happen quickly enough.

I would like to see the Minister deliver a restructured VHI. Perhaps she would indicate a timescale for the break-up of the company to provide a level playing field. I have a certain sympathy for the other players in the insurance market, namely, VIVAS Health and Quinn Healthcare, that have to pay risk equalisation to the dominant player in the market. It does not make sense that the VHI controls 70% of the market. I heard all the arguments about community rating and why this must happen and I accept them, but it is not fair that the VHI can operate differently from other health insurers in the market. I accept the Bill is going some way towards remedying the anomaly that exists. The dominance of the VHI must be addressed. I welcome this start to the process and hope it will not be too long before we see a competitive health insurance market where all players are approximately the same size.