Helen McEntee (Meath East, Fine Gael) | Oireachtas source

I thank the Senators for their support, for the most part, for the Bill and for their contributions to the debate.

To recap, the main purpose of this Bill is to specify the risk equalisation credits and corresponding stamp duty levies from 1 April 2017. The Bill also makes a number of changes to the operation of the scheme, providing for a new benchmark of reasonable profit for the over-compensation test and placing a limit on the amount of credits that can be provided. The Bill also clarifies the circumstances where an insurer can withdraw a product and seeks to ensure that people are offered a replacement product with at least the same level of benefits.

Sharing costs across the community-rated private health insurance market must take account of the realities of the market and, as Senator Colm Burke mentioned, our increasing population and demographics. The proportion of people in their 70s with health insurance has increased by almost 40% in the past 13 years and the proportion of people over 80 years of age with health insurance has doubled. At the same time, there were large decreases in the proportion of people in their 20s and 30s with health insurance. The introduction of lifetime community rating, young adult rates and the improved economic environment have helped to reverse this trend. To echo Senator Colm Burke's point, the number of people with health insurance is generally associated with employment levels. As our unemployment rates continue to decrease and as we continue to offer incentives to encourage young people to take up health insurance, we hope that number will not stabilise but will continue to increase.

These changes, coupled with the ongoing increases in employment, which is a key driver in the demand for health insurance, will support the market and everyone wishing to avail of private health insurance. The Bill provides for 10% increases to the existing stamp duty levies. However, the Bill's primary purpose is to provide the necessary credits to insurers to reduce some of the additional costs they incur by insuring older, sicker members. It is proposed to increase those credits significantly to insurers. These changes will not offset all of the additional costs of insuring older and less healthy people, but they will help to keep health insurance more affordable for them. With regard to the percentage based stamp duty, in 2015 and 2016 one of the insurers indicated a preference for switching to the percentage based stamp duty. While this view has been taken into account by the authority, it has not recommended changing from the current system of fixed amounts to stamp duty. Under the scheme all of the money raised in levies from insurers is paid into a fund for the sole purpose of supporting the market in the form of credits payable. Any decision to pass on the benefits of higher credits or the cost of higher stamp duty levies to consumers is a commercial pricing decision for each insurer.

Most Senators raised the issue of public versus private health care. Changes to the charging regime for private patients in public hospitals have contributed to some of the increase in claims costs. The Minister for Health, Deputy Harris, recently met with all of the health insurers and listened to their concerns about charging private patients in public hospitals. I understand the HSE and insurers have met twice since then to discuss and resolve the issues. There is ongoing engagement, which is welcome. People using our public hospitals are fully entitled to opt to be treated as public patients. If they hold private health insurance, they are also free to waive their entitlement to public treatment, opt to be treated as private patients and use their private health insurance. The charges for private patients in public hospitals go towards meeting part of the cost of providing the hospitals' services to private patients.

As regards the issue of universal health care, and in recognition of the issues outlined by Senator Devine, the Committee on the Future of Healthcare is examining this issue. I hope we can achieve a system of universal health care in the future with a role being played by private health insurance. However, that is something to be discussed in that committee. This Bill allows us to maintain our support for the core principle of community-rated private health insurance. By revising the credits, and the stamp duties required to fund those credits to take account of market trends, we can continue to provide the necessary support to ensure that the costs of health insurance are shared across the insured population.

I commend the Bill to the House and I agree with Senators that further discussion will be required at a future date.