Sean Barrett (Independent) | Oireachtas source

I welcome the Minister of State, Deputy White, my former colleague from the Oireachtas Joint Committee on Finance, Public Expenditure and Reform, to his new post. He was a brilliant Chairman of that committee and the expertise in finance he will be bringing to the Department of Health is most important. I wish him well in his role.

I wish to outline some thoughts about primary care centres. In the past we had dispensaries and we had a choice of doctor schemes. I have some concerns and hope this has been properly costed. In the past medical graduates used to convert the garage or the front room of a house into a GP office. If we get the State and public private partnerships involved - I know the Minister of State has an interest in that from his previous role - will we just end up with the money going to builders, auctioneers, bureaucrats and so on? It was a simple product and many people would say that the GP service was the one that did not fail. People did not have to wait for years to see a GP. I wonder if, following some of the recent controversy, it might merit re-examination. What was wrong with what we had previously with physiotherapists and others setting up practice at home? While it was not a one-stop shop, let us ensure we are not creating a new cost base and involving the State in new capital expenditure.

The Department's document indicates that we have invested approximately ¤5 billion in health capital projects in the past ten years. Some of it was used earlier than that to convert hospitals such as Dr. Steevens' Hospital into offices. It is a heavily bureaucratic service and I hope the Minister of State will be able to run that down. Based on numbers discussed in the earlier debate with the Minister, Deputy Reilly, the fastest increasing area of the health service since 1980 has been in the number of administrators and clerical people. This is about people treating patients.

We need to speed up the introduction of universal health insurance. Some 36% of the population have medical cards and there are other grades of medical cards. As approximately half the people already have private health insurance, let us go for it. I hope the Minister of State will get an opportunity to review a version of the Milliman report on hospitals and the VHI that is less redacted than the one supplied to us. We have a very long average length of stay. I note from the Minister's speech that this has been reduced from 8.7 days to 7.9 days. However, the Milliman report gave an example of a treatment that would take 3.7 days where best practice applied internationally and took 11.6 days here. That adds approximately ¤1,000 a night to every in-hospital treatment covered by VHI.

The report also stated that very little analysis, appraisal and value-for-money research has been done within VHI to ascertain whether health insurance prescriptions and the overall costs were unduly high. I had hoped that competitive health insurance would drive down costs and excessive lengths of stay. There is material on that matter that the Minister of State might like to look at. My amendment was to move faster to universal health care provided it is done in a competitive way so that instead of saying that a particular company charges less for health insurance because it cheated by recruiting only young people and not old people, one would rather say it was because the VHI had had a monopoly with too many monopolistic habits. If old people can be allocated equally among all the competing insurance companies, we would get better value.

I have heard GPs make a further point - one the Minister of State and I would have had in common in a previous time as members of a board of a university. Milton Friedman and Simon Kuzsnets, both Nobel Prize winners, said in the 1940s that if the American Medical Association were allowed to determine who could go to medical school and what foreign doctors could practice in the United States, it would result in a very expensive health service. I believe they were right given that it accounts for approximately 17% of gross national income in that country.

What kind of health service would we have had if universities had not been so adept at turning away students with 550 points seeking to enter medical school in the past 25 years? Would that have given a much more patient and consumer-orientated service? Was it good value from the national point of view that these highly qualified and talented people who wanted to study medicine and had all the points were kept out? There was a particularly daft attempt to weight that through the HPAT because too many women qualified - this was opposed by the Minister, Deputy Reilly, and also the former Senator, Dr. Mary Henry. Keeping out of medical school some of the most talented people the country has produced over the past 20 years must have had knock-on consequences for the service the Minister of State is seeking to organise in the consumer's interest. Perhaps he might also review that matter.

The Minister also spoke about public private partnerships which really need to be examined. In other fields, as the Minister of State will know from his time as Chairman of the Oireachtas Joint Committee on Finance, Public Expenditure and Reform, the results were doubtful. I believe in a public sector and a private sector. When they come together, I am not so sure that the public sector has typically got a good bargain for the citizens as a whole.

The Minister of State is very welcome to the House and I hope he comes here many more times. I wish him every success in his new role. As we said to his senior colleague, the Department of Health has been the toughest job in Irish political life for a very long time - it has damaged the political careers of many who have held ministerial office there. It is most important that the Government succeeds and I wish the Minister of State well in his endeavours.