Feargal Quinn (Independent) | Oireachtas source

I welcome the Minister to the House. The system in China used to be that the doctor was paid only for keeping a person well, but not when a person took ill or went into hospital. I think that is a lovely incentive. Perhaps we should to try to do something like that with insurance. I agree with the Minister that investing in health insurance is like investing in a pension. Some of the measures introduced in this Bill will nudge people in the right direction, such as the penalties for those over the age of 35 who do not take out health insurance.

There are much wider problems in health insurance. Earlier this year I introduced the Health Insurance (Reform) Bill 2014. The playing field in the health insurance market is not level because the biggest player is not subject to the same rules and requirements as its competitors. The Minister for Health is the largest shareholder and provider of private hospital services in the market through the Health Service Executive, the shareholder of the largest health insurer in the market, the VHI, and the regulator of the health insurance market. That is an unhealthy set of circumstances. It can also mean that there is a financial impact on the HSE and on the VHI. Health insurance providers are required to have a solvency margin of at least 150% assets over liabilities and a solvency ratio of 40% - that is, the company’s free assets should equate to 40% or more of its net written premiums over the previous 12 months. However, the VHI is not required to meet these solvency requirements. A 2011 decision of the European Court of Justice ruled that the VHI should be regulated in the same way as other non-life-insurance providers in the State. In 2012 the European Commission requested that the State end the unlimited guarantee provided to the VHI. The Bill I introduced aimed to effect this request. The lack of competition resulting from the present situation is not good for the customer, and these aspects of the health insurance market need to be standardised.

I do not believe this has been considered from the point of view of the customer. The customer is the citizen, the person who uses health insurance.

In general terms, policy decisions affecting the health insurance sector should not be driven or influenced by decisions which are taken solely in the best interests of the VHI or the HSE. We need to foster much more competition to benefit the customer. I believe that a fairer and competitive health insurance market would be to the benefit of the public.

Perhaps the Minister will comment on the current situation around health insurance, including whether we will eventually move to a fairer market. On wider health insurance reform, I believe we need to move from reactive health care to so-called health maintenance. We should have a health insurance scheme that encourages people to stay healthy. I will give an example. Some foreign health insurers reduce premiums for persons who are members of a gym or buy healthy food, which they can validate via a receipt from the supermarket and so on. Many health insurers in Europe and elsewhere offer incentives to those who have their vital signs and statistics monitored and hit particular goals, with those whose records show a reduction in blood pressure being rewarded with lower premiums. In Ireland, cheaper premiums are offered to drivers who drive safely. Why are we not offering cheaper health insurance to those who look after their bodies?

Some US health insurers offer discounts to those who have gym equipment and medical devices that can be used at home. Why can our health insurers not do more in this area? I know of a very large supermarket in South Africa, Pick n Pay, that introduced such a system for its employees who join a gym - it is not good enough to only join it as they must prove they work out there - and lose weight or give up smoking. Surely our health insurers could do more in this area. It makes a great deal of sense to reward healthy and active people.

There are other innovative developments. For example, a health insurance company in South Africa has introduced a programme that applies the air miles model to health care, namely, a person earns points by taking up sport, exercising, purchasing healthy food or by hitting certain targets in respect of weight loss, etc. That company has even formed partnerships with businesses to provide rewards linked to what are known as vitality levels. One supermarket there provides discounts of up to 25% on 10,000 healthy foods. Retailers here could look at this example. There are many things we can do to encourage people to stay out of hospital. This is not just a question of the doctor being paid when a person is well and not being paid when he or she is ill, but I believe that is also a good way to go.