Sean Barrett (Independent) | Oireachtas source

I support section 8 and did so on the night of the budget. This is a subsidy which members of the Houses of the Oireachtas intended to be for sick people but it has been transformed into a provider subsidy, as the Minister has just described. I fear that the same thing has happened with pension subsidies. It is the industry which benefits and not the consumer, the intended beneficiary. The figure provided by the Minister of an 86% increase in four years is astounding. Apropos of the recommendation from Senator O'Brien, data from the Brookings Institution indicates that medical inflation in the United States is finally coming in below consumer price inflation. The United States has traditionally had the highest medical costs in the world, equating to 17% of gross national income. Our rate of 11% probably puts us second, or very close to it, on the list. The Minister is right to ask the awkward questions about what this subsidy is for.

I have mentioned the 2010 Milliman report on private health insurance in Ireland in this House previously. That report found a limited focus on investing in ways to manage claims, regardless of the risk profile of the population or on the need to limit inappropriate treatment with no proven medical benefit. What are subsidising here? The Minister is right to ask value-for-money questions. The Department of Health must have a stronger focus on the sector because we cannot continue with 85% increases in four years. The aforementioned report also found that there is considerable opportunity to reduce utilisation through avoiding unnecessary admissions and reducing the length of stay. The report contains data on the average length of stay for inpatient admissions. In Ireland, the average is 10.6 days while best international practice is 3.7 days. Senator O'Brien has already referred to the charge of €800 per night for seven unnecessary days in hospital. Page 37 of the Milliman report refers to the fact that attempts to reduce the average length of stay for inpatients have run into "push back" from medical consultants.

This is not gold-plating. These guys are solid gold the whole way through. They do not plate the ornaments. Let us say, for the sake of argument, that we decide that we are only accepting 3.7 days and are not going to pay for 10.6 days. That would be one way to tackle the problem as opposed to the method opted for in the budget. My amendment was judged to be outside the scope of the Bill but in it I was trying to increase the Minister's chances of being able to do it, if HIQA gives us references for length of stay and appropriateness of treatments.

Senator Burke wins the Peter Mathews prize for advocacy on the question of the cost of drugs. That is one of his leading topics. Newspapers today are reporting that some drugs here cost more than twice the reference rate in Spain. In some instances, our drugs cost 90% more than elsewhere. We are trying to help sick people here but it looks like a tax break for tax payers is benefiting the insurers rather than sick people. In terms of recommendations to try to stop the cost going from €0.5 billion to €1 billion, some reference point is required so that we can judge whether treatments are unnecessary or excessively expensive and would not meet the qualifications set by Milliman. Mr. Pat Mc Loughlin is preparing a report on this area for the Department. He has already submitted a report on cost-saving in local government. We must confront this issue head on. This is a tax break that has ended up benefitting seriously rich people in this country and not sick people. I believe the Minister is right to tackle it. As long as a tax break continues, we must deal with average length of stay, the cost of drugs and the appropriateness of medical procedures. We must figure out why we pay so much more than the Spanish for our drugs and why we have such high levels of unnecessary hospitalisation for excessively long periods and why the bill for all of this-----