Dáil Éireann debate -
Thursday, 4 Feb 1937

Vol. 65 No. 2

In Committee on Finance. Supplementary Estimates. - Vote 44—National Health Insurance.

Mr. O Ceallaigh

I move:

Go ndeontar suim Bhreise ná raghaidh thar £6,229 chun íoctha an Mhuirir a thiocfaidh chun bheith iníoctha i rith na bliana dar críoch an 31adh lá de Mhárta, 1937, chun Tuarastail agus Costaisí i dtaobh Riaracháin na nAchtanna um Arachas Sláinte Náisiúnta, 1911 go 1934, agus an Achta um Pinsin do Bhaintreacha agus do Dhílleachtaithe, 1935, agus chun Ilsíntiúisí agus Ildeontaisí, ar a n-áirmhítear Deontaisí áirithe i gCabhair mar gheall ar Chostas Sochar agus Costaisí Riaracháin fé sna hAchtanna um Arachas Sláinte Náisiúnta.

That a Supplementary sum not exceeding £6,229 be granted to defray the Charge which will come in course of payment during the year ending on the 31st March, 1937, for the Salaries and Expenses in connection with the Administration of the National Health Insurance Acts, 1911 to 1934, and the Widows' and Orphans' Pensions Act, 1935, and for sundry Contributions and Grants, including certain Grants-in-Aid, in respect of the Cost of Benefits and Expenses of Administration under the National Health Insurance Acts.

The bulk of the increased gross provision is accounted for by an additional amount estimated at £10,000 under sub-head F (2) required to meet: (a) the Exchequer proportion of the expenses of administration of the Unified Society, and (b) increased expenditure on sickness benefits. As regards (a), certain expenditure fell to be made in the current financial year out of the administration account of the Unified Society in respect of purchase of premises and setting up a superannuation fund for staff. Provision had been made for it in the year 1935-6, when £11,669 was unspent under this sub-head generally, but the final issues of moneys for the purposes referred to were not made until 1936-7. The balance of the proposed additional provision is due to estimated increased sickness benefits during the current financial year.

Under sub-head AA, the sum of £88 represents additional provision required owing to all work on the 1933 valuation of the Unified Society being unexpectedly completed in the current financial year by the British Government Actuary. This work is performed under an agency arrangement. With regard to sub-head G, District Medical Referee Service, the additional £220 is required by the number of persons attending for examination before the district medical referees being greater than was estimated for.

The gross total additional sum required is, therefore, £10,308, which is partly offset by a saving of £200 under sub-head A, Salaries, etc., and by an estimated increase of £3,879 in Appropriations-in-Aid due to the fact that the amounts recovered from the Widows' and Orphans' Pensions Fund were in excess of those estimated for. These amounts are recovered in accordance with Section 43 (2) of the Widows' and Orphans' Pensions Act, 1935, in respect of expenses incurred in the administration of the Act. The net Supplementary Estimate is accordingly £6,229.

Mr. Dockrell

I had rather thought that the Minister would have made a more detailed explanation under this Vote, because some of us had hoped that under the provisions of amalgamation there would be considerable savings in the cost of administration. The Minister now says that there is a saving of £200 in the additional Estimate, and he refers us to sub-head A in the main Vote. When you turn to sub-head A in the main Vote you see that it is Salaries, Wages and Allowances, an item which is increased by £7,400, so that, presumably, there is now a saving of £200, which decreases the increase from £7,400 to £7,200. Some of us had thought that, presumably, the advantages of amalgamating all those insurance societies would be increased benefits and decreased cost of running the national health insurance. Personally, I am very sorry that for another year apparently the additional benefits which the worker was supposed to get have been swept away. The Minister will remember that certain insurance societies had increased benefits, and that those now disappear. We were led to suppose that there was going to be a saving in the cost of administering the Act. Apparently the workers are not getting more benefit, while there have been more contributions heaped on the employer. One would think that with decreased benefits and a decreased amount of work there would be a saving.

I do not know whether any Deputies in this House have read the statement which is laid on the Table of this House, and I do not know whether we are to read this additional Estimate in conjunction with that. I would like to say that personally I do not approve of the procedure there adopted, because apparently the employer is expected to do a whole lot of work which was originally done by the approved societies. The employed person, or "the insured" whichever you like to call him, is going to be taken out of the picture altogether. Apparently he is now not going to have any responsibility at all.

I would like now to call the Minister's attention to some matters that will arise under those revised regulations. The employee objects because he will not have an opportunity of finding out whether his card has been stamped for the period of his employment. His employer has to send in, over his head, his insurance card to the National Insurance Society. The employer objects from the filing point of view. The receipts are at present in alphabetical order. In my young days I read a story about "Convict 99." Apparently employees are now to be referred to not by their names but by their numbers. That will be the position in the working of the National Health Insurance Society. The order in which the files are kept will necessitate a separate file making future reference to the individual record more complicated. In the second place extra work is involved in keeping the files or lists which the Insurance Society now demands. The names are not to be handed in in alphabetical order—in the order in which the employer has them. They must be arranged in a digestible form for the society. That extra work will come at an awkward time, at the end of the half year. At the present time individual receipts can be got ready for signature at any time. Lists will have to be prepared at the time of the disposal of the cards or at the time when employees may be dismissed or taken on.

In the case of dishonesty on the part of the employer—and I suppose there are dishonest employers—the fraud would not be discovered for six months or possibly a longer time than six months. The card that would have been supposed to have been sent in may not have been sent in at all. There is another matter I have to mention and which I do not think is at all fair. The employees will have to be interviewed as to whether the correct particulars are entered on their cards. Apparently, that additional burden is thrown on the employer. The employer runs the risk of a large outlay at any time when called upon to stamp cards. If any irregularity—with which the employer possibly would have nothing to do—were discovered it may be very prejudicial to the employer. That is the sort of irregularity that should have been discovered sooner if the present system were continued.

I have already referred to the fact that the cards will have to be put back in alphabetical order on receiving them from the insurance society. The new cards received from the society, presumably in numerical order, will require alterations on being put on to the alphabetical files. When the approved societies were working, most of the employees handed in new cards when coming to sign for or stamp their cards. This has not been the case since the amalgamation took place and very many cards are now in arrears.

I would like to call the Minister's very serious attention to the undesirability of cutting the employee out of this transaction altogether. This is a system in which everything is done for the employee—his contribution is deducted off him, his card is stamped by the employer and is by him handed to the insurance society. I am not complaining so much about making deductions or stamping the cards, but I think it would give an additional protection if the employee were asked to stamp his own card. I think it is a most undesirable practice to have the responsibility for the contribution withdrawn altogether from the employee.

It is rather hard to understand why, in the face of decreased benefits and decreased work on the part of the amalgamated society, we are faced with increased costs. Perhaps the Minister can excuse it by saying that there are decreases in the increases. I would like the Minister when replying to deal fully with this point and also with the regulations which, I take it, are to be made in conjunction with the present Supplementary Estimates which have been laid on the Table of this House.

An Ceann Comhairle

The Minister to conclude.

Mr. O Ceallaigh

This is only a Supplementary Estimate. Therefore in the brief statement that I read I only dealt with the sub-heads with which we were primarily concerned—with the moneys that we are seeking. I did not make any general statement with regard to the working of the national health insurance system during the last year or explain whether there was any increase or decrease in the cost of administration or the numbers or anything of that kind. I do not know whether I would have been permitted by the Chair on a Supplementary Estimate to give a review of these matters.

An Ceann Comhairle

The Chair had some difficulty in endeavouring to bring the contribution of Deputy Dockrell under any of the sub-heads of the Supplementary Estimate. Administration and general policy are not debated on a Supplementary Estimate. However, if the Minister desires at the request of the House to go more fully into the matter, the Chair will not rule stringently. But it will not be permissible, when the Minister has concluded, to proceed to debate the general policy of national health insurance.

Mr. O Ceallaigh

We will have an opportunity in probably less than a month of going into the whole matter when the ordinary Estimates come up for discussion. The whole question of national insurance policy can then be gone into by any Deputies interested in the subject. The primary cause of the demand for an increased Vote here, arises from the fact that the amalgamated society is instituting a superannuation scheme for its staff. The increase is £10,000 but this is modified by decreases on other heads and the net increase is £6,229. It is because of the institution of this superannuation scheme that this Supplementary Vote is required.

There are one or two other items to which I wish to refer—the actuaries and the medical referees. There is a slight increase in the one case of £88 and in the other an increase of £220. But the real cause of the need for the Supplementary Vote is in order to provide for a superannuation scheme for the staff of the National Health Insurance Society.

Deputy Dockrell referred to the question of decreased benefits. Except in the case of a very small number of societies and a relatively very small proportion of members of National Health Insurance there have been no decreases. There was a small number of societies that were in a kind of privileged position. Because of certain types of persons that belonged to those societies, the societies were in a position to give better benefits to their members than were the vast bulk of the societies that existed before unification. The members of the societies able to give special benefits have certainly lost, and so far as that small number is concerned there are decreased benefits. For the vast majority of the insured there are neither increased nor decreased benefits. Deputy Dockrell referred to a regulation and said that it put an extra burden on employers. That, I would like to tell him, is not a regulation. It is merely a voluntary arrangement that was suggested to certain employers in Dublin and Cork who had a large number of employees, and they were asked whether it would not be a convenience for them as well as for the societies. They need not put it into operation if they do not like. Most of those who were asked did put it into operation, and thought it was an improved system. However, if Deputy Dockrell thinks it is a serious burden neither his firm nor any other firm employing a large number of employees who are subject to National Health Insurance need adopt the scheme. It was believed that it would save time and trouble to all concerned to have the thing done in that way. It is certainly some disadvantage, so far as an employee is concerned, but there is nothing to prevent an employee satisfying himself that his card has been duly stamped. He can ask to see the card, and see that it is stamped. The responsibility is, to a certain extent, taken off his shoulders by reason of the fact that the employer is trusted to act properly. It is purely permissive, and there is no obligation on an employer to adopt the system if he does not wish to.

Mr. McMenamin

With regard to sub-head F (2), I understood from the Minister that the provision made here was for disablement benefit for the staff of a society, but it does not say so here.

Mr. O Ceallaigh

It is in connection with the superannuation scheme that has now been adopted by the National Health Insurance organisation for its staff.

Mr. McMenamin

The implication here is that it is for the society.

Mr. Dockrell

The Minister has reminded me that the Estimate will be coming up before the House in a couple of months' time.

Mr. O Ceallaigh

A month.

Mr. Dockrell

But the Minister knows that the Estimates are usually carried under the closure.

Mr. O Ceallaigh

No, no.

Mr. Dockrell

However, if the Minister does not wish to go into the matter now, I suppose it can be raised later. Certainly, if this is a voluntary scheme for the employer, that is not the way that it was put to the employers. It involves a lot of work on the employer, and I do not think that employees would like to have to be trotting into the office asking to see their cards every month as to whether the stamps had been stuck on them or not. I do not think that employees would get much encouragement for that procedure.

Vote put and agreed to.