Vincent P Martin (Green Party) | Oireachtas source

As always, the Minister of State is very welcome to the Chamber. As has been stated, Ireland has a community-rated voluntary private health insurance market, which means all people pay the same price for the same health insurance policy. The risk equalisation scheme is the mechanism designed to support the objective of our community-rated health insurance market.

The content of this Bill, which is largely technical in nature, is to be broadly welcomed as a fair approach to health insurance provision.

I will use some of my time to point out that the Bill highlights and reminds us about the divide in the Irish health provision, between public and private services. While it is a very important Bill for people who rely on private health insurance, it is worth noting that it also ensures fairness across the system and guarantees that sicker people or those at risk are not paying more for their policies. However, as I stated, it highlights the unfairness in the health service that forces people to take out health insurance for fear that if they get sick the public health system will not be able to treat them in a timely manner. The health budget in Ireland is approximately €22 billion, yet around 50% of people here take out private health insurance. We are very much part of a two-tier system. The current two-tier health system has failed many. The creation of a waiting list acts as a perverse incentive, creating a need for patients to purchase health insurance in order to access treatment, as it offers the safety net of being able to access treatment if the need arises. That is because they are aware of the two-tier system. The result is a system of unequal access to healthcare with arbitrary barriers to access and often preferential access for those who have the financial wherewithal through taking out private health insurance.

In all, there are currently approximately 897,000 on hospital waiting lists in Ireland. There are more than 97,700 children on waiting lists, which is one in four children on their respective lists for more than a year. The child and adolescent mental health services, CAMHS, have a waiting list of 3,914 children. Some 53% or 1,808 of them are waiting for less than 12 weeks for an appointment, while 9% or 221 are waiting longer than 12 months.

We hope Sláintecare will herald a change. The Green Party policy on health is to support the reform of the health system through Sláintecare. This includes a single-tier health system based on need rather than the ability to pay, which is funded through general taxation. It includes multi-annual budgeting, activity-based costings and blended capitation schemes to incentivise efficient, targeted use of resources through our health system; a fully-funded national service of public health nurses at an advanced level, who would engage with patients in their own homes and who could refer patients, as appropriate. We must properly fund the wonderful people on the front line.

Sláintecare includes increased numbers of advanced paramedics who could treat patients in their own homes so that they would no longer have an essential need to go to hospital. It is intended to have extended services in community pharmacies to increase the support for general practice services. Sláintecare will provide for more investment in general practitioner services to allow for minor procedures and specialist services to take place outside of hospitals. It is intended to reform the Health Service Executive and to set up local community health organisations which will include a balance of community and patient participation as advised by healthcare professionals.

There is a process in place through the Government to respond to the ongoing waiting list situation, but it has not yet resulted in what I would consider to be significantly reduced waiting list numbers across the public system. The Government says it is working with the Department of Health and the National Treatment Purchase Fund to improve access to care, fund weekend work in public hospitals, use private hospitals and provide virtual clinics. The latest news is the effort made to get consultants to work in public hospitals. It is all to be welcomed if people will buy into it, and if we attract consultants home.

The cancellations that occurred during the height of the Covid-19 shutdown continue to have an impact and the health service is still catching up with it. A task force has been established as part of the 2022 waiting list action plan to reduce waiting times, yet they continue.

I have used much of my time to concentrate on the elephant in the room, but I want to be fair – I know the Minister of State, Deputy Butler, in particular and the Government have made progress. I would like to put that on the record and commend it. Much progress has been made, but at a time like this when we are discussing a technical Bill, I want to draw attention to the long-standing reality of inequality in the system which is still a two-tier one. In the longer term, I would like to see that addressed.