Colm Burke (Fine Gael)

I thank the Minister for bringing this important Bill to the House today. I wish to deal briefly with last week's Bill, on which I made my views quite well known. I believe section 3 of that Bill gave a blank cheque to drug companies because it made it quite clear that once it was approved by the European Medicines Agency and once it was prescribed, the HSE had to provide it. There was no connection between section 3 of the Bill and section 5 relating to the powers of the Minister. That was my concern about it.

Regarding the availability of drugs, there is the issue of European regulation on cross-border health care, which will have an effect on us here. Access to medical care and drugs will be affected by that directive which was passed by the European Parliament, Commission and Council in February 2011 and we have 30 months within which to implement it.

The figures for 2000 to 2009 show that spending per capita on pharmaceuticals in this country increased by 8.7%, which was the second highest increase in OECD countries. The cost to the State has increased dramatically between 2000 and 2010. While the briefing note from the Department referred to a 185% increase, my calculation is that it is a 230% increase. The general medical scheme increased from €338.8 million to €1.233 billion, the cost of the drug payment scheme from €140 million to €173 million. Costs for long-term illness increased from €41.7 million to €126.9 million. The cost of high-tech drugs increased from €51.9 million to €361.2 million. In total, costs increased from €573 million to €1.894 billion, a 230% increase in ten years. That represents a huge drain on the medical services. One of the reasons we need the Bill is to tackle this increase. Between 2000 and 2008 the cost of the drug payment scheme incresed from €143.6 million to €311.9 million. While there was a reduction thereafter, that represents a very significant increase in a very short time period.

I have an issue with the cost of drugs in hospitals. I do not know if we have figures on the amount hospitals spend on drugs. I have seen estimates of approximately €300 million. Do we have a breakdown on the cost for each hospital? The Minister might not be aware that some hospitals are now giving prescriptions to people to buy the drugs outside the hospital even though they are being administered in the hospital. I presume this is being done to remove that cost from their budgets. A cost is now being added to the State in that procedure and that issue needs to be addressed.

In addition to an increase in the cost, the volume of drugs used has increased dramatically. Between 1997 and 2007, there was an increase from 20 million items used per annum to 40 million items. We need to consider whether doctors feel that regardless of the complaint they must immediately prescribe. We all have a responsibility in this regard.

There is also an issue with the cost per item. An item that used to cost €11.50 in Ireland cost €3.50 in Brussels. Last week I spoke to someone who now buys their drugs when going to Spain. The cost here is €120 and the cost in Spain is €40 for the same drug. In 1997 the average cost per item under the GMS was €11.20 and is now €23.27, which is a substantial increase in a very short time period.

The Bill is welcome. Of 29 countries across Europe, 23 are using generic substitution. We are considerably behind in that the amount of generic substitution is only approximately 18%, which is extremely low. The Bill is comprehensive in dealing with that. The area is currently governed by section 59 of the Health Act 1970 and there has been no major reform in more than 40 years. It puts the obligation on the health service in the purchase of medication and drugs. The Irish Pharmaceutical Healthcare Association has raised concerns over the Bill. Those concerns need to be considered as we deal with the Bill.

We need to get value for money in providing health care. We have allowed costs to increase substantially in a very short period of time. Last year we spent more money on health care than we got in income tax. We have considerable work to do to ensure we get value for money in the health service while at the same time ensuring we can provide a comprehensive health service. While we are doing that at the moment we must ensure we use the budget we have effectively in order to provide a comprehensive health-care system for the entire population. When people criticise the health-care system they often fail to take into account that the number of people with medical cards has gone from 1.146 million to more than 1.76 million and the figure is very close to 2 million when those with GP-only medical cards are included. We now have a reduced budget to provide health care for a far larger number of people with a 50% increase in the numbers under the medical card scheme. We need to deal with those issues.

We have major challenges with the health-care system. The Minister is dealing with those challenges and this is just another step in dealing with it in a comprehensive and careful manner. This Bill is just one of the issues we need to address. I look forward to the Committee Stage debate and to seeing the legislation pass through both Houses of the Oireachtas and implemented.