James Reilly (Dublin North, Fine Gael) | Oireachtas source

Consultants who have not seen patients should not sign forms that say they have seen them. That is the law and if that is not the practice, there is a problem and it will be addressed. It is idiotic that consultants have to sign the forms and we will decouple this but, at the same time, we have to do so in a fashion that ensured proper probity around hospital claiming because we cannot have a scenario where a manager claims that a patient was in the hospital and he or she claims for many procedures that have not been verified as having been done but I agree with the Senator that the consultant should have to sign the forms. The current system needs to be changed and we are examining that. In the interim, we have a new mechanism for supporting consultants in making the claims on time in order that the forms are signed off.

I am afraid Senator Barrett made a number of statements that do not stand up, one of which is that getting older does not impact on illness and claims. Everybody who has done credible work on this will provide evidence to the contrary. It is clear that as the population gets older, there is a higher incidence of cancer and chronic diseases. He said that people are cheating but I reject that. Nobody is cheating. We are trying to ensure older and less well people are not targeted for higher fees. This is not an ordinary market similar to car insurance. This is health insurance and there is a Government policy in place, which supports community rating whereby those who are well support those who are unwell and those who are younger support those who are older, as previous generations did.

A key question is why there is such a low number of older people in the new insurer's clientele. If this was such a dreadful market and we are all so nasty and mean, how has it been possible to attract a new insurer this year in GloHealth? Of the three new insurers why are so few of their clientele over 65 years of age? The reason is obvious, the other insurers are targeting younger people, by creating products that are not attractive to older people. Now VHI has started to do it. One will find that very few of the standard policies available cover things which will be looked at by older people. How many people in their 40s consider they will need a hip replacement? How many people in their 70s consider they might need one and yet prosthesis are gone off the standard policies? How many people think they will need a cataract procedure, an issue on which many older people will be focused? That is taken off the standard policy. Segmentation of the market is taking place and we have got to battle that. All the statistics argue against the Senator in that regard. I appreciate the Senator's comments about getting rid of the HSE as quickly as possible, in terms of what it stood for in the past. We are well advanced on that issue. This, as Senator John Crown has said, is an interregnum to get to universal health insurance. I will deal with that issue more comprehensively later.

Senator Gilroy mentioned the two-tier system. I could not agree more. This is why we are committed to universal health insurance in order that people are treated on the basis of medical need, not on ability to pay. He mentioned the consultant who said that, had he realised that the patient he was treating was a private patient, he would have treated the patient himself. That is something we are trying to end through the new contracts with consultants. How does it fit with universal health insurance? This is very much the preamble to introducing universal health insurance. While we have VHI with its not so dominant role in the market at 57% but its hugely dominant role at the paying out end of the market at 80%, we want to tackle these costs and we will tackle them.

Senator Bradford raised the issue of cost containment. A new cost containment committee is in place in VHI, from which I have asked for a much more robust audit and, for the first time ever, a clinical audit. It is astonishing there was no clinical audit up to now where a team of clinicians could challenge the treating clinician or surgeon as to why a particular procedure was done. If found to be unnecessary, the next time he or she does it, he or she will be fined. There is a whole issue around the procedures. Instead of paying per day, there should be a payment per procedure. In that way the hospitals that are efficient will thrive and those that are not efficient will not thrive. The issue of what we pay is being reviewed. In the past,15% was taken off the top of consultant fees. I want a more nuanced approach. There are certain procedures that used to take two hours but now take 20 minutes. Why pay the same amount for those procedures? There is a clear focus in VHI that it must tackle its costs.

Senator Crown also mentioned tonsillectomy. I wish I could share his confidence that is the case. As a general practitioner, I know that if I send a child with tonsillitis to a surgeon the odds are the child will have a tonsillectomy whereas if I send the child to a paediatrician, the odds are that there will not be a tonsillectomy. That speaks volumes. It is interesting to note that in the UK where it stopped paying for tonsillectomies, the incidence of-----