12th June, 2001
Dr. Henry: I welcome the Minister and the Bill. He should not apologise for his speech because it was a model of clarity. I am delighted that executives from the VHI and BUPA are in the public gallery and heard how seriously the issue was addressed by the Department.
This is a most important matter and the introduction of effective risk equalisation is the only way affordable health insurance will be possible. The community solidarity that existed in Ireland through risk equalisation between generations has been extraordinarily important. Any of us who are aware of situations in other countries, such as the United States and Germany where this did not prevail, know it was a great problem for those who were insured and who lost the ability to pay for insurance at the time they most needed it. It was also a problem for the insurance companies which did not want risk equalisation. The Minister has got it right and I welcome the Bill. The Minister will work out the details of the risk equalisation and we must trust him with that task.
The Bill is fair to insurance companies by allowing a three year period before a new company can enter the market. In addition, and perhaps more importantly, it removes what I describe as frills. It deals with the core of health insurance where risk equalisation applies. Dental and optical treatment or getting money if one is out of work are additional benefits and they will not be affected by the Bill. I wonder if the Minister could also include the hotel accommodation aspect. People do not appear to understand that an enormous amount of the health insurance premia for the higher categories relates to what I describe as hotel accommodation. However, the Minister has struck the right balance.
People occasionally say to me that they have never claimed and they should get a rebate. However, I tell them they should be glad that it has not been necessary for them to claim. It would be terrific if one had insurance for 30 years and never had to claim. That would not be bad and I wish I could say the same. However, the Minister has made a big improvement in the Bill.
One could quibble about whether health insurance is now voluntary or almost obligatory. I do not blame it all on the Minister, but 30 years of neglect in terms of financing the health service has created a bad mess. This is one of the reasons there is such a high number of people in the private health insurance sector. It is extraordinary that almost 50% of the population has private insurance and this takes away from the benefits of having private health care. One was supposed to have easy and immediate access if one needed it, but people in the public health service who complain about how long it takes to get an appointment to see a specialist at a hospital or to have an operation should check what is happening in the private health service because the queues there are also long.
When I knew the Bill was coming up, I took the opportunity to find out if consultants had appointments for mythical patients that I would refer to them. However, no gynaecologist had an available appointment within two months. I said I had a patient with acute arthritis of the knee, but the earliest appointment to see an orthopaedic surgeon was four months. It was much the same story regarding ophthalmologists and if one had a rash, it would have consumed one entirely before one got to see a dermatologist. The position with regard to back pain is almost impossible in the private sector.
There is a serious problem because, over the years, a sufficient number of consultants was not appointed to deal with a population that is now demanding first class health care. It is unfortunate but that is the position at present. Regarding the cancellation of operations, I am aware of people in the private sector who need hip and knee replacements, but their operations have been repeatedly cancelled. It is worthwhile noting that it is not only happening in the public sector. However, one marvellous aspect - the Minister should grapple them to his heart with hoops of steel - is the availability of family doctors. Public and private patients do not have to wait very long to see them and that is extraordinarily important. The gatekeepers of the system are in a position to see patients and say that something is wrong with him or her.
However, an unfortunate aspect at present is that people are being sent to accident and emergency centres to try to ensure they are referred to hospitals. From both the public and private perspectives, it would be good if family doctors had more access to X-ray facilities, physiotherapy services etc. This would cut down on the number of referrals to hospital specialists and it would be a great saving for private health insurers. They allow payments to family doctors for certain items and perhaps this could be extended to other facilities in hospitals. However, facilities are so pressurised at present that there is a tremendous reluctance among those working in hospitals to allow access to those who work outside hospitals.
I spoke recently to an oncologist who mentioned the length of time he must keep people in hospital to ensure they have CAT scans, given the length of the queues for such scans. This is enormously wasteful of money and an undesirable consequence for the health of the patient. We are all distraught when the treatment of people with cancer and other acute illnesses is delayed. This is the priority area that must be addressed at present. However, an improvement in the facilities available to family doctors within hospitals would ensure a great financial saving to the public and private systems. It would also be extraordinarily important for patients.
When Mr. Patrick Plunkett resigned from the board of St. James's Hospital because of the conditions in the accident and emergency department, I visited the department and it was appalling to see two or three people with cardiac failure lying on trolleys. Some had been there for hours and had blue faces, hands and legs. They were on drips and it was terrible that those patients were not transferred immediately to hospital beds. There is also the worrying sight of people waiting hours and if their family doctors had access to x-ray facilities they would not have to be there at all. I hope the Minister will regard this as one of the priorities for his Department.
There has been much talk about the extension of hours of opening of the specialist clinics attached to hospitals. This would cost a great deal of money because the nursing staff, secretarial staff, porters and administrators, as well as the consultants, must all be paid to staff the clinics. While I am sure that to a business person it sounds like the ideal solution, the costs involved would be extraordinarily high.
Competition between health insurers is a good thing because a single operator can become complacent. I am a plan A/B person myself and I am always fascinated by people who pay really high prices just to have hotel-quality accommodation. The clinical care will be the same for everyone, and that should be emphasised. A public patient in a hospital will receive the same clinical care.
I am constantly told by my colleagues of the terrible delays caused by the failure to upgrade equipment, much of which dates from the early 1990s and is now obsolete or just worn out. The Minister knows only too well that replacement costs were not factored in and those costs have to be covered now. I hope that future health programmes will include the cost of replacement so that hospitals are not trying to work with bits of radiotherapy equipment which are only fit to be museum pieces and not fit to be used on patients, public or private. The upgrading of services is very important. Breakdown of equipment means that patients are waiting longer. There should be better co-ordination of tests. Private hospitals make more of an effort in this regard and that policy could be extended to the public hospital service.
The Minister for Finance, the Minister's friend and perhaps co-operative colleague, introduced tax relief for the building of private hospitals in the last Finance Bill. This was very odd and shows that he has settled on the idea of the separation of the public and private hospital services. I would not be too enthusiastic about that, having seen both systems in operation. The mix ensures that the level of service is raised for all patients. For example, the consultants are then tied to the hospitals and this is preferable to having them crossing the city to another establishment.
One of the proposals for this tax relief measure was that these private hospitals should have accident and emergency departments. I wonder if the Minister is aware of the cost of setting up and staffing an accident and emergency facility. The cost is astronomic and we certainly do not want to see Mickey Mouse accident and emergency services set up. If people are not in need of proper accident and emergency facilities, then they should be seen by their family doctor. It would be better to supply facilities for family doctors to improve their establishments so that they could undertake more in the way of treatment than is possible at present.
I compliment the Minister on how children are treated. It is very important to explain to people that when it comes down to brass tacks and children are seriously ill, consultants do not have public and private lists. In the case of cochlear transplants, no child can be a private patient because all the children are assessed in terms of medical need. The same applies for paediatric cardiac cases. All the consultants weep about is that they cannot treat all those who need urgent treatment. As a result, the Minister and his Department have been involved in the transfer of children to other jurisdictions. Our main problem is not the lack of cardiac consultants to do the operations but rather the shortage of nurses for nursing care in the intensive care units. I am aware that the Minister knows this all too well.
It is important in talking about private and public health care for children that we acknowledge there will be a difference in the treatment of children for problems with tonsils and adenoids. Orthodontic treatment will be totally different. As far as I can see, buck teeth will never be straightened out in the public system at the moment. Parents should be assured that when it comes down to brass tacks their children will be looked after in both systems.
I am thinking of tabling an amendment to section 5 of the Bill. This is the section which obliges the insurer to offer premia on an equal basis on the grounds of age, sex and sexual orientation. I suggest a proposal for genetic profile. I know that the Cathaoirleach is aware of my requests that we do something by way of legislation regarding genetics. I may suggest that at Committee Stage. We in Ireland are in the forefront of genetics and there is no legislation on the subject.
I congratulate the Minister on the Bill.
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