Colm Burke (Fine Gael)

I thank the Minister for giving a comprehensive presentation on the reason for the Bill. It is important that we have in place regulations and legislation which are for the common good. It is also important there is no price increase in health insurance as people get older and may be unfortunate to have an illness. That is one of the things the Bill provides for as was also provided for in 2009.

We are spending more than €13 billion on health care annually. That is a huge budget. While there is much criticism of the health care system many improvements have taken place for which we do not give credit, in respect of hospital care and out-patient care. The number of patients going through the hospital system has increased dramatically and we should give recognition to that. Also there are those who consider that health care is an important issue and take the trouble to take out health insurance. The Minister of State said that more than 47.5% of people have health insurance, which is a high percentage of the population. However, the Minister of State would accept there will probably be a decrease in that area in the next 12 months given that people are coming under more pressures. Therefore, in terms of competition, it is important to ensure we get value for money, whether in the private or public sector.

When the risk equalisation scheme was being dealt with in the courts, everyone had the same idea, that nobody should be penalised in respect of health insurance. While the Supreme Court held in 2008 that the way the mechanism was put in place was ultra vires it did not strike down the principles of community rating but the mechanism provided under the 2003 regulations.

The provisions between 2009 and 2011 which allowed for ten year bands are being amended to five year bands. This provides for a more comprehensive overview in respect of credits and benefits for the over 50 age group. That is a welcome development.

While the Minister made a comprehensive presentation of all the issues I wish to refer to the VHI, the private health care sector and the lack of competition. There appears to be a view that what happened for the past 20 years must continue for the next 20 years. I do not agree with that. There are certain issues about which I have concerns. I raised this matter at the Joint Committee on Health this morning and previously with the Minister. I have taken the trouble to file a formal complaint with the Competition Authority in respect of the decision by the VHI not to give cover for a new hospital in Cork. It cost over €50 million to build and equip four operating theatres with brand new MRI equipment and other state-of-the-art equipment, yet it cannot get VHI cover. The other two insurers have agreed to give cover. It is interesting that the Mater private, which intends moving into that facility, has now written to the VHI stating it is prepared to quote 6% under the quote of the other major health care provider in Cork, which proves the point that competition brings down price and gives better value for money.

The VHI is a State agency in real terms. Why is this happening at a time when we are debating the issue of giving protection to the insurer that has a large proportion of the over-50 age group yet, at the same time, it is not prepared to take on board cost savings? It is a serious question and needs to be dealt with. I know the Competition Authority has met one of the parties although I am not sure if it has met the VHI yet. It is anti-competitive that the major provider of insurance in this country is refusing to give additional cover.

It is interesting that the other major provider, while it is not happy another company is intending to come into its space, has a proposal and full planning permission to build a new 80-bed extension to its facility. This does not make sense when, in the not-too-distant future, I am sure VHI will give cover for that new 80-bed extension to the current occupier of the bulk of the private market in the Cork area. It is definitely an issue we should consider.

A growing issue in health care is the fact over 500,000 Irish people are currently aged over 65. In the next ten to 20 years, that figure will grow dramatically and it is predicted by 2031 over 1 million people will be over the age of 65, which means we will have to ensure adequate health care facilities are available. We need to begin planning carefully for this change, and while we are very restricted in regard to budgets and the money available, this does not prevent us from long-term planning. Whether it is a ten, 15 or 20 year plan, we should consider it now. I know we intend to go forward with the universal health care plan, which is very welcome and is about having everyone on a level playing field so that all have an equal opportunity to access health care services and facilities, which is important. However, we need to do a lot of long-term planning, and now is the time to deal with that so we can achieve cost efficiencies.

In some cases, health insurers will provide cover where the person is admitted to hospital for a procedure whereas many procedures can now be done on an outpatient basis. I am not sure the health insurers have reviewed this issue in recent years. Many cost savings could result from making sure they provide the right cover, given they will not provide cover if the procedure is done on an outpatient basis but they will provide it if the person is admitted to hospital. The Minister of State has outlined the position in regard to admission on the night before a procedure and has sought and achieved some changes in that regard, with resulting savings. It is this type of area we can work on to bring down the costs health insurers have to pay. The insurers themselves have an important part to play in this, and they must be proactive in bringing down costs.

I welcome the proposal and the presentation by the Minister of State. She has my full support and that of my party for putting the legislation in place in the next 12 months.