Feargal Quinn (Independent) | Oireachtas source

The Minister is very welcome to the House, because he is one of the Ministers who comes on a regular basis and he gives us the opportunity to say what we have to say, even if some of us are very critical.

I welcome the objective of the Bill and what the Minister is trying to achieve. Having listened to Senator Barrett, however, I believe we are going to have to change the system in some way or other. I cannot believe the costs we have in Ireland.

Singapore is a country the same size as Ireland. It has a population of 4.6 million, about the same as ourselves, but it has a health system that costs 3.8% of GDP, compared with ours which costs 8.2% of GDP. The health service in Singapore costs ¤1,000 per capita. Ours costs ¤2,800 per capita. Admittedly, Singapore has an 80% private and 20% Government system. What can we do to reduce our costs? We have not taken even the first step in that direction. I spent a night in hospital recently, and I am covered by insurance. I could not believe the price the hospital charged the insurance company. There must be some better way of doing it.

Let me touch on the Singapore model. The Singapore Health Minister explained it as follows. Patients are expected to co-pay part of their medical expenses and to pay more when they demand a higher level of service. At the same time, Government subsidies help to keep basic health care affordable. The model works by mixing public and private health care. In the Singapore system the primary role of Government is to require people to save in order to meet medical expenses they do not expect. There are mandatory health saving accounts called medisave. Individuals pre-save for medical expenses through mandatory deductions from their pay cheques and employers' contributions. Approved categories of medical treatment can be paid for by deducting from one's medisave account for oneself, for grandparents, parents, spouses or children, and consultation with private practitioners for minor ailments must be paid for in cash.

There are clearly systems that work in a different way. One journalist wrote in regard to the Singapore system:

The reason the system works so well is that it puts decisions in the hands of patients and doctors rather than government bureaucrats and insurers. A key principle of Singapore's national health scheme is that no medical service is provided free of charge regardless of the level of subsidy even within the public health care system. This mechanism is intended to reduce the overutilisation of health care services.

This is something we experience here. This may be unpopular to say but it is a bugbear of many people that medical card holders use their cards unnecessarily for prescriptions and so on. In addition, many people do not want to take up employment out of fear of losing their medical cards. We need to examine this issue because people need to be disincentivised from abusing the system. If a patient has long-term back pain, why do GPs send them to accident and emergency departments? Is the Minister considering measures in this regard?

Picknpay. a supermarket company in South Africa, provides incentives to encourage staff to stay healthy. Discovery, an insurance company, provides health cover for the staff and they are on reduced premia if they stop smoking or reduce their weight or, for example, can prove they use a gymnasium. Safeway in the US does something similar and it has reduced heath care costs dramatically because staff have been encouraged to stay healthy. We can learn by looking at what is done around the world. We do not have to automatically continue with the system we have. I am particularly impressed by the contributions of Senators Crown and Barrett. I hope the Minister will take account of some of what they said, if not all of what they said. We must change the system. The Minister hopes to introduces universal health insurance by 2016 but that will not happen unless costs in our health care system are tackled.