asked the Minister for Health if farmers, who are currently insured and whose PLV exceeds £31 approximately, will have to make heavier financial contributions under the terms of the proposed revised health scheme.
11.
Ceisteanna—Questions. Oral Answers. - Revised Health Scheme.
10.
asked the Minister for Health if non-manual workers earning in excess of £2,600 per annum, and who are currently insured, will have to make heavier financial contributions under the terms of the proposed revised health scheme.
12.
asked the Minister for Health if manual workers earning between £50 per week and £96 per week approximately will have to make heavier financial contributions than at present, under the terms of the proposed revised health scheme.
With the permission, of the Ceann Comhairle, I propose to take Questions Nos. 10, 11 and 12 together.
The flat rate health contributions originally fixed in 1971 have been increased at intervals to allow for increases which were taking place in the cost of the limited eligibility services. A further increase would have been necessary in the coming financial year to cover cost increases. This factor should be kept in mind when assessing the points at which persons at present liable to pay contributions at the existing flat rates may be paying more under the new scheme of income related contributions.
As the new scheme is income related it is inevitable that some persons will pay more but those with lower incomes, and in the case of farmers, those with lower valuations will pay less. This is one of the primary objectives of the scheme.
May I draw the Minister's attention to the fact that although the information given is useful and factual he has not really replied to the question? Can he say whether farmers whose PLV exceeds £31, whether non-manual workers whose income exceeds £2,600, and whether manual workers earning between £50 and £96 per week, will be paying more under the proposed so-called free scheme than they are paying at present?
The Deputy will understand that I cannot give any definite answer to that question because by April of next year it is certain that the existing level of health contributions would have been increased. We do not know by how much, but it would certainly have been increased in accordance with normal annual practice. We would have to compare the amount payable under the new pay related scheme with what the amount would have been if the new pay related scheme had not been introduced. It is difficult to settle that point. In the case of the worker I should like to make this additional point, that somewhere around £50, £60 or more the insured worker may be paying more under the health contribution but up to about £80 he will be paying less under the social welfare pay-related scheme. I am sure the Deputy will agree the worker does not go to great trouble to see what particular deduction is going where. It is the effect of the combined deductions in which he is interested.
Is it not a fact that the insured person to whom I referred now pays 50p a week or £26 a year and, under the terms of the scheme as announced by the Minister some time ago, he will be paying 1 per cent of his income? Is it not the case that people earning over £2,600 per annum will be paying more under the terms of the new scheme than they are paying at present?
He will pay more than he is paying at present, but he would have been paying more anyway next year in the normal course of events.
The answer is yes.
The general justification is that if you have a pay related scheme—and I am sure the Deputy will subsribe to this principle—the idea is that you help the lower paid, and if you help the lower paid and you want to give the same level or a better level of services, somebody must pay a bit more.
I subscribe entirely to that, but would the Minister not agree that it is incorrect to term the scheme a free scheme when, in fact, it is an insurance scheme?
The Deputy knows full well nothing in this world is free. Someone is paying for it somewhere.
The Minister sometimes forgets to mention that when he is having a press conference.
13.
asked the Minister for Health if manual workers earning in excess of £5,000 per annum will lose eligibility for the refund of maternity and other costs under the terms of the proposed revised health scheme.
Under the proposed changes in eligibility any person whose income is over the limit of £5,000 per annum will be responsible for paying the doctors concerned for whatever services they provide. This includes medical fees for maternity services. His or her entitlement to services will not otherwise be affected.
I should add that in the light of the proposed changes the Voluntary Health Insurance Board have agreed to include in their scheme a substantial provision for maternity care. The details have not yet been fully settled but the board will give adequate notice of their proposals.
The Deputy may have in mind specifically the subsidy which is paid by health boards towards the cost of private or semi-private accommodation in hospitals and nursing homes. Under the revised arrangements everybody, irrespective of income, will be entitled to this.
Is it not a fact that manual workers who are covered at present for in-patient maternity services and consultants' costs will lose their eligibility for those services under the proposed new scheme?
Some will. Some workers who are at present entitled to limited eligibility, if their income exceeds £5,000 per annum or whatever the limit may be fixed at, will lose the benefit of consultants' fees on the one hand and maternity benefit on the other. We are making very adequate provision for those people under the Voluntary Health Insurance Scheme. The Deputy will understand there has to be a break-off point somewhere. I think everyone in the House agreed that the old system was entirely unsatisfactory and gave rise to enormous difficulties in administration and discontent among the general public. Therefore, we had to have some clear line of demarcation and £5,000 a year is a reasonably generous level. It is one and a half times the latest published average industrial earnings figure, and it will be reviewed again before the scheme comes into operation finally on 5 April.
Manual workers, mainly skilled workers, earning over £5,000 a year will be asked to pay almost twice what they are paying at present and will lose the benefit of eligibility for consultants' and maternity services.
That is not the position. We hope under the new Voluntary Health Insurance arrangements to make adequate provision for them to enable them to cover themselves for consultants' fees and maternity benefit at negligible cost to themselves.
Under the terms of the so-called comprehensive scheme the Minister announced, will they not lose those benefits?
As I said before, we will have an opportunity to discuss all these things when the legislation comes before the House.
The answer is very simple: yes or no?