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Dáil Éireann debate -
Wednesday, 7 Nov 1956

Vol. 160 No. 5

Voluntary Health Insurance Bill, 1956—Second Stage (Resumed).

Question again proposed: "That the Bill be now read a Second Time."

I was pointing out that under the Health Act, 1953, where the total earnings of a household exceed £12 the members cannot avail of free medical and surgical treatment. Similarly, where the valuation of the property exceeds £50 they are deprived of the opportunity of availing of any such benefits. In relation to ratepayers, where the valuation exceeds £50, they contribute substantially in the form of rates towards financing free medical and surgical treatment for those below the £50 valuation or the £12 per week gross earnings limit. These two classes will now be enabled under this Bill to avail of insurance at reasonable rates. We are indeed indebted to the people who examined this matter for the very valuable data they have given us and the very reasonable terms they have succeeded in presenting to us in the form of statistics. I notice they selected County Tipperary, North and South Riding, for the purpose of giving us the most suitable statistics. However, reading through the report, it would appear they have based their calculations to a great extent on the figures obtainable from other countries, such as the United States of America, Australia, Belgium and Denmark. Now here we have a very large rural community and a great number of individual families rather than groups, organisations, unions or societies in which schemes such as this can be more easily operated.

I notice from the figures made available to us that a married couple with one child can have certain benefits on the payment of £9 15s. 0d. per annum. These benefits would include hospital treatment, nursing home maintenance, surgical fees and medical fees, etc. I think that premium is very reasonable. I do not think we can expect the service at that premium to be made available immediately because it would depend on a very large number of subscribers of a wide age range at the very beginning.

It is probable at the outset that this voluntary health insurance scheme will appeal to, if you like, older people, people nearer to middle age or past middle age who appreciate the necessity for health services. I do not think it will immediately appeal to the youth, to the people who do not appreciate the importance of good health and who have not had the experience of ill-health.

I do not agree with some previous speakers that contribution to maternity benefits should be optional. I am in favour of a spread over. It was pointed out in the Report of the Advisory Body that on a contribution of £5 a family expecting to require maternity benefits would be covered. That contribution of £5 would be required from such families on a date nearly a year before the birth is expected in order that the scheme might be successful. I am inclined to the view that it would be better to have maternity benefit contribution spread over all the people. I do not agree with the calculation made here to-night that it would cost £3 10s. 0d. to a married couple to contribute to maternity benefits which they might never require themselves. I do not agree the premium would be that high if spread over all the people.

As I said, I am in favour of the inclusion of a maternity benefit premium in the general scheme. Of course, there are arguments, particularly from the point of view of older people, against the payment of an amount which would include a subscription towards maternity benefit costs. I feel that when these benefits are to be provided under this voluntary health insurance scheme, it will be necessary that such benefits to be uniform, should be classified and specified. There are insurance companies who provide what is called a policy covering all illnesses. They do not specify any particular illness or any particular treatment. These insurance companies, however, give cash benefits and leave it to the individual contributors to make their own arrangements. For certain premiums the contributor may get £10 a week or £5 a week during his illness, according to the premium paid.

I feel that when this board is set up and when the scheme goes into operation there will be very heavy demands on it during the first five years. During that time people who have joined the scheme probably will belong to the upper-age class rather than to the younger class. It is probable these people will require medical and surgical treatment sooner. It is probable that people of that age have had previous illnesses from which they have not completely recovered and that they will join the scheme in order to gain advantage of the benefits provided. The result is likely to be that for the first four or five years there will be a higher average number of claims than there will be at a later stage when younger people are brought into the scheme and when a larger number of people are subscribing to it.

I should like to mention, too, that it will be necessary to ensure that a large number of people will subscribe to the scheme. We had an example in the last couple of years of a well-known insurance company providing medical and surgical treatment for a countrywide organisation. After a time they were compelled to modify the benefits provided and to double the premiums. That insurance body catered for one group only. If different groups had been provided for the company might not have had to increase its rates. The explanation given as to why this company had to discontinue was that persons of the older age group took advantage of the benefits that were provided. The company would have lost heavily in the first few years but would have balanced out when various classes of persons were being catered for. Probably there were very heavy claims during the first couple of years.

It is not quite clear from the Bill whether it is proposed to provide cash payments for people who become entitled to avail of the benefits. I know that insurance companies do provide the cash. It seems to me that the board intends, instead, to pay the costs, probably at specified figures and fixed amounts for various services. The insurance companies who provide a similar class of insurance usually provide the cash and leave it to the individual to look after the expenses himself.

If the board is to be constituted as proposed under this Bill it will not be very attractive to the members who would be required to operate on it because, running right through the Bill there seems to be a good deal of insecurity so far as board members are concerned. A member is there at the will of the Minister, he is removed at short notice; the maximum period of office is five years and the question which arises is what type of individual will abandon whatever his present occupation is and take on a job for five years and then find himself on the scrap heap after having given his service on the board, if the Minister desires to replace him by another person or discontinue his services? I feel, as it stands, the Bill will not encourage the right type of person to become a member of the board owing to the insecurity that seems to run right through the clauses of the Bill for any man who would volunteer at the outset to go into this employment and come under the orders of the Minister in the operation of this voluntary health insurance scheme. However, it is worth a trial.

Looking back, it is obvious that the health insurance already available to the people, has not been availed of. On this occasion, the Minister in his position on behalf of the State, proposes instead to establish the board and to sell this insurance and provide the benefits to those who join on a national basis. Although the public in general have not up to this availed of health insurance to the extent they might have done, I feel, now that the Minister for Health is going to set up this scheme, there will be a good response, particularly from the people who are not eligible or qualified to avail of the benefits ordinarily available under the Health Act, 1953, and the Social Welfare Act, 1952.

I feel this scheme will be successful, but I am inclined to think that the Minister must be ready to provide for losses in the operation of this health insurance scheme for at least the first five years. If he is not prepared to stand the loss for at least the first five years, it will be necessary for him to have a very much higher premium than those quoted by the members of the Advisory Body who investigated the possibilities of this scheme. For that reason I think we should hear from the Minister as to what he intends to do in the first five years of the operation of this scheme, because I believe it will not be sufficient for him just to begin by advancing a repayable loan. I think he would have to be ready to bear losses in the operation of the scheme at the outset if reasonable premiums are to be available to those who contribute and who wish to avail of the benefits.

I heard the Minister say, in reply to another speaker, that everyone could become associated with this health insurance, which is voluntary. That means that those in the middle income group, as well as those in the higher income group, may avail of it. It also means that people who, by right, should be members of the lower income group, that is, the public assistance class, must in some counties avail of it. I think there is a situation there that needs to be clarified and put on some uniform basis.

We have, for instance, counties where a man with an income of £7 per week has a medical card and is entitled to all benefits available to what is known as the public assistance class. A man similarly circumstanced with, say, four or five in family, in another county having the same income is not in possession of a medical card, which means that he has to pay for medical services. What will happen under this scheme is that in one county you will have certain persons availing themselves of this insurance or compelled to avail of it, whereas in other counties persons similarly circumstanced financially have free services under the 1953 Health Act. That is something that will mitigate against the success of this measure, something I would urge the Minister to get straightened out before this schemes comes into operation. Otherwise there will be all sorts of grievances and bickerings among a large section of the people and these are the very people who would help such a scheme.

If this voluntary health insurance is left to the higher income group I think it will have teething troubles from the very start and for a long time. It is only by getting others into it that it can be successful, but before doing that we should have uniformity regarding the issuing of medical cards.

Debate adjourned.
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