I welcome the introduction of this Bill. It is very important legislation which will allow the VHI to move into the next century in a strong and positive manner.
People must recognise the tremendous service provided by the VHI which was established under a Government led by Fine Gael. We must be very proud of the role it has played during the past 40 years. In the region of 35 per cent of the entire population contribute to the VHI and are under its care. It is a non-profit making organisation and the wealth it has created has been reinvested in the provision of health care for its contributors.
The fact that the VHI's administration accounts for only 6 per cent of its overall cost is a tribute to how it has been managed. The health insurance industry is entering a competitive market and we must ensure that the people who are most vulnerable obtain and retain health insurance at a reasonable cost. I specifically refer to the elderly and chronically ill. Health insurance is mainly family-based and has been extremely beneficial. However, the country is faced with an ageing population. We must ensure that the VHI, in its new format, and any new competitors do not engage in cherrypicking and abandon vulnerable sectors of the population to a difficult situation.
The health service will change dramatically in the coming years. The Minister and his predecesssor worked closely with the health boards as they move into a new era of health care. It is envisaged that people will spend shorter periods in hospital and convalesce at home or in nursing homes and the VHI must gear itself to take account of that. If necessary people could be paid an allowance which would enable them recuperate at home instead of in hospital.
Consultancy services in rural areas, particularly in Cavan-Monaghan, should be improved in order to provide a service for people close to their homes. People would not have to travel to the Blackrock Clinic or the Mater Private Hospital if health care services were decentralised. The Bill gives an opportunity to the VHI to be better placed to meet the challenges of the future and that is one of them.
Middle income families with children at college or facing other extraordinary costs find it difficult to meet, in many cases, exorbitant VHI subscriptions. They must pay their doctor's bills and medication, dental care and physiotherapy bills. The VHI should devise a package that would give access to such care at a nominal rate. The membership of VHI is such that a package could be offered at a relatively low cost. Group schemes are in operation which offer discounts to participants and perhaps a similar scheme could operate for ordinary medical care.
As there is peace in Northern Ireland we should consider aligning our hospital care facilities with those in Northern Ireland. When we consider the level of health care in Altnagelvin Hospital it seems sensible to have an arrangement not just at health board or Government level but at VHI level with that hospital. In Cavan-Monaghan and in Louth many people have family connections in Northern Ireland and it would be more convenient for them to be hospitalised immediately north of the Border or in some of the extremely good hospitals in Belfast. During the troubles in the North great expertise was built up in such hospitals, particularly in the Royal Victoria. This could be tapped into in providing ordinary health care service. The Minister and the VHI should examine this possibility. It would introduce competition which might help to lower costs. It might also result in speedier access to treatment which would help those suffering from chronic illness.
Services have been developed at local level. There is a scanning machine in Cavan hospital and major improvements were made in Monaghan hospital. This has resulted in the earlier diagnosis of illness at local level.
The Minister examined the area of private care for the elderly. It is right that he should have control over that and ensure proper services are available but he might also look at the level of care in private hospitals. The majority of patients in private hospitals receive extremely good care and treatment but we must be certain that the best care possible is available particularly when State or VHI funds are involved. We must be certain that top quality nursing and medical care is available. In general hospitals there is continuity of nursing staff. That is important as a term in hospital for a person is a traumatic time for the patient and the family. We must ensure that patient care, for which the consumer is paying a hefty insurance premium, is of the highest quality. The experience of some families who pay high premiums and are hospitalised in private hospitals is that the level of care is less than what they anticipated. They would also have experience of care available in general hospitals. The Minister should examine this matter.
The VHI should have customer help lines. That may be difficult to operate but the customer is often alienated from the provider. This particularly applies to those who participate in group schemes. People should know what services are available and if they have a problem they should have access to somebody who will help resolve it.
For example, if a person is diagnosed as having cancer he or she should know exactly what treatment is available. There should also be a fair complaints procedure. I hesitate to suggest the office of an Ombudsman in the case of the VHI because of the danger of it being unable to negotiate with hospitals and so on. However, people must be able to have their complaints dealt with.
The VHI has provided a great service for many years. Many people owe their lives to it because the health services could not have coped with the increasing numbers of open heart surgery, triple by-passes and so on that have been carried out in recent years if the private hospitals, which are funded mainly through VHI, had not been available. The majority of people are satisfied with the service provided by the board.
The health care consultative forum which the Minister proposes to establish next spring will play an important role in the provision of public and private health care and the VHI has a major role to play in that. I wish its chief executive, Brian Duncan, every success in promoting further changes in the system and this Bill will enable the board to compete successfully in the next century. In any business changes are necessary, otherwise we would move backwards. There is an onus on the chief executive, the board and all concerned to ensure that the VHI provides as good a service, if not better, in the next century.
The VHI is a major business. In the last financial year £224.5 million was paid out in hospital and consultancy care, £107 million of which was paid to private hospitals, £60.3 million to consultants and £57.2 million to public hospitals. When account is taken of the number of public hospitals perhaps that balance should be re-examined to ensure that as many people as possible are treated in their home environments. The fact that 35 per cent of our population are members of the VHI is a tribute to the service and the operation of the board. It is interesting to note that only 12 per cent of the UK population are covered by similiar health insurance.
As costs are bound to increase, the VHI must endeavour to make the best deal possible with hospitals and consultants. It is important that the Minister maintains some control to ensure that increases are at a minimum. If costs are too high young people may opt out of health insurance and, while this would provide them with cash in their pockets in the short-term, it would have serious implications for them and the VHI in the longterm. It is important that the VHI, in consultation with the Minister and the Department, ensures that increases are kept to a minimum and that a maximum number of people are covered by health insurance, thus providing a good balance between private and public health care. Our public health care is of a high calibre. If one compares the position in places such as the United States and Canada one must acknowledge the major improvements that have been brought about in health care here, through a mix of private and public services.