Finian McGrath (Dublin Bay North, Independent) | Oireachtas source

I thank the Senators for their contributions to the debate on the Bill. I will go through some of the points raised by individuals and if there are any I omitted or do not have time to respond to, I will revert to the Senators. Health insurance is held by a large proportion of people in Ireland relative to other countries. It is important that we take the opportunity to discuss this Bill and the positive effect community rating and other aspects of health insurance regulation have on people's daily lives. As I mentioned in my opening remarks, Sláintecare will introduce change in how people access the health service, and it may mean that the role of private health insurance in our health service also changes. This Bill supports the role that private health insurance currently plays in our health service as a means of supporting people's access to affordable healthcare.

To recap, the main purpose of this Bill is to specify the revised credits, and corresponding stamp duty levies, to apply on health insurance policies from April 2019. The voluntary health insurance system in Ireland operates on the basis of community rating, which means everyone pays the same price for the same product. This is supported by a scheme which aims to keep health insurance more affordable for older and less healthy citizens. As mentioned by a number of colleagues, in other health insurance systems internationally and in other insurance markets in Ireland, the level of risk presented by an individual directly affects the premium paid. Under this scheme, all 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. The credits and levy rates for next year strike a fair balance between the need to sustain community rating by keeping health insurance affordable for older, less healthy consumers and maintaining the sustainability of the market by keeping younger, healthier consumers in the market.

This Bill will see an increase in the number of Health Insurance Authority board members from five to seven. This was raised by colleagues. This provision will ensure continued strong oversight and regulation of the health insurance market. This change was originally suggested by the Health Insurance Authority board. The Bill will also see some changes introduced with regard to the VHI. The first change is in the composition of the VHI board. The proposed amendment will remove the existing restriction in terms of having only two persons who are "health service providers" on the board. The amendment will also allow for due consideration of the mix of skills present on the board. The second change, which was raised by colleagues, is to ensure a level playing field and to permit the VHI to sell international health care plans directly without an intermediary. This will remove the impediment to VHI's ability to compete and will enable it to avail of significant business opportunities – opportunities that are available to its competitors.

Senator Ardagh made some important points on the legislation. Senator Boyhan referred to the health care, the VHI and the rehab beds. He knows I am working very closely with him on this. He asked, properly, what we are doing. We are spending an extra €700 million in healthcare in 2019. Fundamental questions are rightly asked about where it is going. In my portfolio, for example, we are spending €1.8 billion on disability services. On the broad question as to where we are going, we have a plan and road map in Sláintecare. That is the way forward. This is linked to Senator Devine's question about what we really believe in and the direction we are taking.

I totally agree with the points on simplification, VHI and the governance of the board. The board size is to be increased to make it more efficient and inclusive. As Senator Boyhan said, small boards do not necessarily work, although this view was held a couple of years ago. Senator Colm Burke referred to the rise in the number of board members from five to seven and to board efficiency. When I am in here, he regularly makes a point on value for money.

There was a debate between Senator Devine and Senator Colm Burke on the nurses issue. In 2014, there were 34,509 in the system. This year, 2018, there are 37,220, representing an increase of 2,711. Senator Devine raised the issue of nursing vacancies It is a problem. I take her point on inequality in our health system. Senator David Norris touched on that also. We have to deal with this. As far as I am concerned, we have started but we have a long way to go. I take the valid points on the principle of universal health care. We have to achieve cross-party support on this. I feel very strongly that Sláintecare is the way forward.

Senator David Norris referred to his experience of VHI. One has to make tough decisions in one's personal life. The Senator obviously made the right decision. The best of luck to him in that regard. He made a very important point on supporting the community rating and unaffordable prices. These are all important points.

I mentioned the change to ensure we have a level playing field to permit VHI to sell international health care plans directly without an intermediary.