Feargal Quinn (Independent) | Oireachtas source

The Minister of State is very welcome. She is a regular in this House and I am glad to see her here. I am not so sure about the Bill. I am wary of supporting anything that has the potential to push up health insurance premiums and thus force people to leave the health insurance system. Senator Crown has described this very well today. It was interesting to hear the Minister say that, according to the report, the Government hopes to raise €120 million from the combined measures in the Bill next year. It is regrettable that the motivation for this Bill seems to be cost saving rather than benefiting the customer - that is, the patient.

If a person has paid for private health care, why can he or she not be entitled to a public bed, similar to a public patient? This case was made very well by Senator Darragh O'Brien. If one has a private car, surely one should also be entitled to take public transport at the same cost as someone without a private car. That is what is happening here. We must take a much more long-term approach rather than focusing on short-term gain. Professor Colm McCarthy predicted that the market could shrink by 40% in the coming years if premiums continue to rise, and said the Government needs to take a longer-term approach rather than what he terms "patching up a cash hole". His report found that around 85% of customers said they would give up their health insurance if premiums rose by 30%. That is staggering to consider.

I will speak about the wider issue of insurance incentives and encouraging people to stay healthy to save money. According to the World Health Organisation concept, health is not to be seen as mere absence of disease but as part of one's complete physical, mental and social well being. Perhaps we have to examine the deeper causes of ill health and try to find ways the Government can encourage people to take exercise instead of sitting in front of a television like a couch potato, as they call them. Behaviour economists call this "nudging". It is a lovely word. The word "nudge" has been used by the British Prime Minister. He has established a nudge unit in Downing Street. The recent health care law passed in America has a provision to encourage employers to offer wellness programmes. Should we go deeper and see how we can link things such as health insurance to activity? Has the Minister had any consultation in this area? Might she follow the example of the US President, Mr. Obama, and examine how economists could help reduce the burden of our health system?

I know two particular instances in the supermarket business. One is a man called Steve Burd of Safeway, a very big US company. He developed a system to pay his employees huge benefits if they went to the gym, stopped smoking, lost weight, etc. It really worked. He had to put a control system in place to do it, but to hear the enthusiasm with which he talks about it is so interesting. There are other innovative developments, such as the ones by the Discovery group in South Africa. Again, a supermarket company there, called Pick n Pay, has had major success with this. Discovery has introduced a programme called Vitality that applies the air miles model to health care. Customers earn points by exercising, buying healthier food or hitting certain targets. They receive a mixture of short-term and long-term incentives ranging from reduced premiums to exotic holidays. Discovery formed alliances with a host of companies to provide rewards linked to one's vitality levels. Pick n Pay, which is a very large grocery chain in South Africa, provides discounts of up to 25% on 10,000 healthy foods. Retailers here could look at this example. Airlines offer discounted flights for members of the scheme. Discovery can measure whether people go to the gym, rather than just joining, because they must swipe their membership cards.

Discovery says it has solid evidence that participation in the programmes more than pays for the rewards. The active participants are less likely to fall ill, and if they do they spend a shorter time in hospital. It is interesting that Discovery, which is South Africa's leading health insurer, with some 5,000 employees, is entering new markets. It has formed a partnership with Prudential in the UK. Could we attract companies such as this to the Irish market or even take on some of their ideas to nudge people towards a healthier lifestyle so they spend less time in hospital? It is essential, as 80% of health activities in Ireland relate to chronic diseases. Perhaps that is where the private investor and the health service in Ireland can do something to improve the lives of our citizens. I am talking about prevention of illness rather than just curing people. I think it was in China that doctors did not get paid if patients took ill; they got paid if people stayed well. It was the doctor's job to keep people well rather than to cure their illnesses.