Health Insurance Amendment Bill- 2012- Second Stage

I welcome this legislation and congratulate the Minister, Deputy Reilly, and the Department of Health on its introduction. This Bill is another step on the road to the delivery of a health service that is supported by universal health insurance and in which access will be based on need rather than ability to pay. In other words, we will have a single-tier health system at the end of this process. This legislation will ensure we maintain a sustainable and competitive health insurance market as we move to universal health insurance. It is part of a range of actions being taken to that end, including the ongoing development of primary care services. A number of primary care centres have been opened around the country and more of them are in the pipeline. They are working very well to deliver effective health care at local level, close to the patients, and ultimately at a lower cost than that which applies when these services are delivered by the bigger institutions. As they can provide a better quality of service, they are protecting patients’ quality of life. The development of primary care services is another arm of this approach.

The roll-out of special delivery units, which is part of the same process, has been a great success. Objective statistics compiled by the Irish Nurses Organisation demonstrate that special delivery units have considerably reduced waiting times.
In the context of overall reform, I salute the Minister’s achievement of a €125 million transfer from insurers to publicly funded hospitals in 2012. This will assist in dealing with the overrun in the health budget but it is also a correct transfer from private to public when public wards are used. Where private patients use public beds, there has to be a reallocation of resources to match that.

Another aspect of the reform and ongoing development of the health services must be the reduction of costs to the consumer of private health insurance. Greater steps and greater transparency in this sector are necessary. We cannot have arbitrary, almost annual or biannual, increases in the cost of health insurance without very active scrutiny and without rigorous control by the Minister and his Department.

For example, there should be a breakdown of invoices in the private health sector. When somebody has a procedure where a private health insurer is covering the cost, there should be breakdown of all aspects of the costs so it is a very transparent process. This would put an onus on the health providers to provide the insurance company with a proper breakdown which would have to be clear and allocate the costs. There is an inherent saving to be made in this regard and, in any case, proper practice would dictate it should happen. I ask the Minister and the Minister of State, Deputy Kathleen Lynch, who is present, to ensure as a matter of urgency that proper invoicing, with a detailed breakdown, as applies in every other sector, is available within the private health insurance area.

I have also come across sustained anecdotal evidence from people who come to our advice centres and others that, when patients have a procedure carried out, it is performed by a junior doctor, who is in the pay of the HSE – in other words, in the pay of the State. However, the consultant who is in overall charge then invoices the VHI, Aviva or another private health insurer of the patient for the procedure, so there is a double payment for the one procedure. A bill goes to the private health insurer, which is upping the cost of premia, and a bill goes to the State for the fact a junior doctor in the pay of the State performed the procedure. This is outrageous. There is sufficient anecdotal evidence to merit an investigation. I call on the Minister of State, Deputy Lynch, to take this back to the Department and to have this matter investigated as a priority.

There is also anecdotal evidence from people who have told me they have gone for a private procedure and are then brought back for an over-the-top number of check-ups, whether annual, biannual, three-monthly or otherwise. I am not convinced that all of these check-ups are necessary and, as there is certainly not parallel activity in the public sector, one wonders if it is a bit of an industry.

What I am effectively saying is that there is a real onus on Department officials and the relevant Minister and Ministers of State to take a vigorous, investigative, proactive approach to the cost of health insurance for the sake of the consumer and the health service. If we are to move to a single tier health system and universal health insurance, this would be a prerequisite. However, we could not go there without getting competitive, properly priced insurance and evidence-based bills, and without ensuring that only necessary procedures are carried out. I am well aware there is a change in the demographic and in the costs that go with older patients – I am aware of all of those phenomena. However, there is still sufficient evidence to suggest the malpractices that have been identified merit investigation and, at a minimum, merit a response from the Minister on the conclusion of Second Stage. I would appreciate that.

Risk equalisation will provide for the extra cost that goes with certain older people who have certain sets of illnesses, so there will not be a discriminatory factor and the money will be refunded to the insurer where there is extra cost involved. It is really community rating in terms of providing assurance in the long term and it is replacing the interim legislation. It will be implemented from January 2013 and, as a result, many packages have recently been offered to younger people and there has been a breakdown of the market into different segments by the insurers. It is important equalisation is in place and that it is written into the legislation that a person’s contract cannot be broken. It is important that a person who is insured will remain insured by the same insurer right throughout the process and that anyone under the age of 65 who seeks to join a private health insurance scheme cannot be precluded from joining it on the basis of risk. It is important that the older cohort of people, who will cost more, benefit from equalisation and that money will come by way of a charge from the less risky younger sector of the population. Ultimately, everyone gets to benefit from this, it ensures the viability of the insurance companies and it ensures reasonable costs for the person accessing the services.

In conclusion, I welcome the legislation and the interim measures being put on a permanent footing. I welcome the safeguards that are built into the Bill. I appeal to the Minister to examine the cost of health insurance, the prospect of detailed invoicing, the use of junior doctors while the charging is done by consultants, the possible over-use of check-ups and the duplication of activities. We need to be rigorous in analysing any attempt to increase insurance costs.

Senator Joe O'Reilly representing Cavan & Monaghan 2010. | An ExSite website