Amendments Nos. 1 and 3 may be discussed together by agreement.
Voluntary Health Insurance (Amendment) Bill, 1995: Report and Final Stages.
(Limerick East): I move amendment No. 1:
In page 6, line 8, to delete "Subject to subsection (3)".
This amendment arises directly from amendment No. 3 and merely removes the reference in subsection (1) to subsection (3) which is being deleted. The effect of amendment No. 3 is to remove subsection (3) of section 4. That subsection enabled the Minister, by regulation, to increase the number of members on the board beyond the upper limit of 12 persons as provided under subsection (1).
Concern was expressed about this on Committee Stage, particularly by Deputy O'Malley. I have decided to meet the points raised by tabling this amendment. The net effect of it is that the Minister may appoint up to a maximum of 12 members. However, he or she may appoint less than 12 members. The power which was in the draft Bill to vary that upwards by regulation is now being removed as a result of the debate on Committee Stage.
I thank the Minister for taking on board the view expressed by me and Deputy O'Malley on Committee Stage. The Minister suggested it would be possible in future for a Minister to reduce the membership of the board. I said at the time I hoped he was speaking tongue in cheek because I did not think any Government Minister would ever reduce the membership, whatever about increasing it. I appreciate that the situation has been clarified. It is better from the board's point of view and it also strengthens the Bill.
I overheard the debate on this matter on Committee Stage and, from what I recall, it got quite heated at times. Sense has prevailed and the Minister's amendment is a good one.
Amendment agreed to.
Amendment No. 4 is consequential on amendment No. 2 and both may be discussed together by agreement.
I move amendment No. 2:
In page 6, to delete lines 11 to 16.
This amendment was discussed at some length on Committee Stage, and I also raised the issue on Second Stage. I articulated my concerns on Committee Stage about the decision by the Minister to limit the number of health service providers that can be appointed to the board. I felt it was unfair to put a limit on health service providers when we did not impose the same limit on other professional bodies which may well be appointed to the board.
For example, what about accountants, lawyers or other professionals who might be appointed to the board? There could perhaps be a company director who is also an accountant and an accountant representing one of the accountancy profession groups. Because the Voluntary Health Insurance board is involved in health care, any health service provider brings a certain amount of expertise to the board.
I accept that a board, which deals primarily with insurance, cannot have representation from all the people involved in the health care industry. It is unfair, however, to make a distinction between various bodies. We could believe that the Minister, and his successors will not fill the board with all types of individuals who are involved either directly or indirectly in the provision of health services.
The Minister admitted on Committee Stage that he had no difficulty with health service providers who were members of the board at present and stated that at no time had they abused their professional representation while they were members of the VHI board, and we all accept that. There is no need to fear that that might happen in future. However, the Minister should consider removing an unreasonable limit in relation to health service providers, when the same type of limit is not put on other professional who might be members of the board.
(Limerick East): I have reflected on this and decided to leave the situation as it is. I would like the board to bring a number of skills to the management of the VHI. It should not be a representative type of board. There is continuous pressure to make other boards which come under the Department of Health representational in nature. Quite a number of organisations feel they have a legitimate right to be represented.
The medical profession is represented by a number of organisations. If one gives represenation to one on a representative basis, there is pressure to give representation to another. With the best will in the world, we could easily end up with a VHI board consisting, to a very large degree, of people with medical interests. It is important to put some limit on it and limiting it to two is reasonable.
Other skills are necessary. After all, the VHI is not providing a medical service, but insurance. The skills appropriate to running an insurance business are not necessarily the ones which providers of medical services would have although naturally enough, providers of medical services would bring experience to bear which would be very relevant. I am not ruling out having the expertise of service providers but I am confining the number to two. The VHI is under the aegis of the Department of Health and there will be pressure on the Minister to give more and more representation to the providers of health services. It could result in a majority of the board being providers of health services which would not be a good idea. The VHI is an insurance company and should be run on business lines. There will be competition in the business shortly and the formula in the Bill is appropriate.
I accept what the Minister said about not having a representative board. From experience, I know it is difficult for a Minister to make a decision on such matters and make room for people representing the various professional bodies or trade associations. I accept that the VHI board should not be a representative one per se. However, certain skills, such as actuarial, marketing and sales, need to be brought to the board.
What would happen if, having appointed the managing director of a well known company to the board it is discovered five months later that the person's company is indirectly involved in the provision of a health service? If the two health service providers were already appointed will the third person. who is at one remove from the provision of the health service, forfeit his or her seat? If the Minister confines this strictly to two health service providers many other skills may be lost to the board.
(Limerick East): My interpretation——
The Minister will know the procedure of the House. Only one speech is allowed on Report Stage but it is not unusual for the Minister to comment.
(Limerick East): Membership will be confined to two people directly providing health services.
Question: "That the words proposed to be deleted stand" put and declared carried.
Amendment declared lost.
Amendment No.3 was discussed earlier with amendment No. 1.
(Limerick East): I move amendment No. 3:
In page 6, to delete lines 17 to 30.
Amendment agreed to.
Amendment No.4 was discussed earlier with amendment No. 2.
Amendment No.4 not moved.
I move amendment No.5:
In page 8, between lines 4 and 5, to insert the following:
"7.—(1) Not later than the 31st day of March, 1996, there shall be established by the Government, on the request of the Minister, a body to become known as the Voluntary Health Insurance Users' Commission and which is in this Act referred to as ‘the Commission'.
(2) The Commission shall consist of a chairman and not less than seven other members who shall be appointed by the Government.
(3) When appointing a member of the Commission, the Government shall fix his/her term of office which shall not exceed five years and, subject to subsections (7) and (8) of this section, he/she shall hold office on such terms and conditions (other than terms or conditions relating to remuneration or the payment of allowances) as are determined by the Government at the time of appointment.
(4) A member of the Commission may at any time resign office by letter addressed to the Government and the resignation shall take effect as and from the date of receipt of the letter by the Government.
(5) A member of the Commission whose term of office expires by the effluxion of time shall be eligible for re-appointment.
(6) There shall be paid by the Board to members of the Commission such remuneration (if any) and allowances (if any) as the Board, with the consent of the Minister, from time to time determines.
(7) A member of the Commission may be removed from office by the Government for stated reasons, if, and only if, resolutions are passed by each House of the Oireachtas calling for his/her removal.
(8) Where a member of the Commission is nominated as a member of Seanad Éireann or for election to either House of the Oireachtas, he/she shall, upon accepting such nomination, cease to be a member of the Commission.
(9) (a) A person who is for the time being entitled under the Standing Orders of either House of the Oireachtas to sit therein shall, while so entitled, be disqualified from becoming a member of the Commission.
(b) A member of the Board of the VHI or an officer or servant of the Board shall be disqualified from becoming or being a member of the Commission.
(10) The quorum for a meeting of the Commission shall be four or such higher number as the Commission may, if it thinks fit, from time to time, by resolution determine.
(11) Subject to the provisions of this Act, the Commission shall regulate its procedure and business.
(12) The Commission may investigate and decide complaints made by subscribers of the Voluntary Health Insurance about services, operations or customer relations. The Commission may also investigate matters in relation to existing and proposed health insurance schemes and health-related insurance schemes.
(13) A complaint described in subsection (12) of this section may be made to the Commission by any VHI subscriber in writing.
(14) When the Commission proposes to investigate a complaint made under this section, the Commission shall afford the Board an opportunity to comment on the complaint.
(15) As soon as may be after they decide on a complaint made under this section, the Commission shall send to the person making the complaint and to the Board a statement in writing of their decision on the complaint.
(16) When the Board receives a statement of a decision from the Commission in relation to a complaint, the Board shall, not later than fourteen days after its receipt, inform the Commission in writing whether or not the Commission's decision is accepted by the Board.
(17) The consideration by the Commission of a complaint made to it under this section shall be carried out in private.
(18) Unless it considers it inappropriate, the Commission shall, as soon as may be, publish particulars of its decisions on a complaint in such manner as it considers suitable and where it considers that the publication should be by the Board, or should include publication by the Board, the particulars shall be published by the Board in such manner as shall be agreed between the Commission and the Board.
(19) This section shall not apply to a complaint which, in the opinion of the Commission is frivolous or vexatious.
(20) As soon as may be after the end of each year, the Commission shall make to the Minister a report of its activities during that year. It shall also make interim reports on general matters in relation to existing and proposed health insurance schemes and health-related insurance schemes.".
The Minister will agree that a number of strenuous complaints have been made concerning the fact that there is no independent mechanism for investigating complaints made by subscribers. The VHI acts as judge and jury. No one is accusing it of not being fair and impartial but those against whom the complaint is made investigate it.
My proposal is based broadly on the Broadcasting Complaints Commission. Although its expenses are paid by RTE it acts independently of RTE and has proved effective and efficient. There is an onus on us to ensure that a facility to investigate complaints is available in any State organisation such as the VHI. People may feel hard done by, for example, when the board refuses to pay portion of a bill that a person thought would be paid in full.
Many VHI subscribers require specialist treatment. One of the most expensive is an MRI scan. I know subscribers who inquired if this was covered under their plan and were told at their local office that it was but when they submitted their bills to the VHI only part of the treatment was covered. They are aggrieved that they were not given full information. It is not good enough to say that the small print at the bottom of the application form states that the first £X is not covered. The VHI does not have much competition and there should be an independent mechanism, which should be seen as such, to investigate complaints made by subscribers, many of which concern customer relations. The VHI will be a better organisation when such a mechanism is available.
It is interesting that during the past 12 months when I mentioned this proposal on a number of occasions in the House and received a positive hearing from the Minister, the VHI drew up a complaints system to be located within the board which would be independent, fair and so on. The board did not make such a proposal until political noise was made about it. I applaud the VHI for doing so despite being nudged along the way. However, it is not seen by the public to be independent because the board receives the complaints, investigates them and decides them. It would be better if a users' commission investigated complaints by subscribers and matters relating to existing and proposed VHI and health related schemes. It is important that complaints are made in writing to weed out vexatious and frivolous complaints. Such complaints are often made to the Garda Complaints Commission. It is very easy for a commission or complaints body to weed out that kind of unnecessary complaint. It is important that consideration of complaints be conducted in private. I imagine the VHI believes that if it were done in public it might attract much adverse publicity. When complaints and allegations are made they receive huge headlines, but when it is later found that the allegation or complaint is not true the same publicity is not afforded to that decision. That is why I propose that consideration of complaints be conducted in private.
It is important that the board of the VHI be given an opportunity to respond to each complaint. That would probably reduce considerably the number of complaints made, very often in an off-hand manner, about the VHI. It might help to get rid of the idea that VHI stands for very high insurance rather than Voluntary Health Insurance. In a recent statement the chief executive officer of the VHI said that subscribers to the VHI can expect hefty price increases this year. I am sure the Minister was as shocked as I was at that statement which was reported in the newspapers. Subscribers should have an opportunity to respond to such a statement.
The board would be happier if complaints were investigated by an independent third party who would take on board its views and comments in response to a complaint. Even though I applaud the VHI for what it has done in this area, it is important that it is not judge and jury in its own case; that responsibility should be given to an independent commission. There are many precedents for such commissions and I recommend strongly that the Minister agree to the amendment.
(Limerick East): I have reflected very carefully on the amendment proposed by Deputy Geoghegan-Quinn, which is very similar to an amendment moved on Committee Stage on which we had a constructive debate. The Deputy had difficulty bringing the amendment into accord with the rules of the House — Opposition Deputies always have that difficulty because they cannot move an amendment that imposes a charge on the Exchequer. There are technical aspects in the amendment, which I presume arise because of the drafting necessity to bring it into order, that render it an incomplete amendment, but I understand the Deputy's intentions. I am not accepting the amendment although I share many of the concerns expressed by the Deputy. The action taken by the VHI, combined with the remit of the insurance ombudsman, will probably be sufficient to meet the need.
There is no point in having a multiplicity of complaints organisations to whom consumers can make their case. I will certainly keep the issue in mind and see how the VHI Members Advisory Council works. That council held its first meeting on 19 January and therefore has not a long track record. I share the intention and motivation behind the Deputy's amendment, but there is no need for a new statutory body to provide the service envisaged. There is an independent and expert arbiter available under the insurance ombudsman of Ireland scheme, of which the VHI is a member. The terms of reference of the insurance ombudsman provide that she will receive references in regard to complaints, disputes and claims made in connection with or arising out of policies of insurance effected or proposed to be effected with members of the scheme. There are about 50 insurance companies participating in the scheme, which means that VHI members are on an equal footing with the generality of insured persons as regards access to independent redress of their grievances. The insurance ombudsman is able to assist by conciliating between the insured person and the insurance undertaking and by adjudicating in a matter of dispute.
It is particularly noteworthy that the undertakings who are members of the scheme have agreed to be bound by the ombudsman's decision. Policyholders are free to accept or reject the decision and may take legal proceedings if they do not agree with the decision. The insurance ombudsman publishes an annual report, which ensures transparency to which the Deputy referred as a necessary element of such a system. Accordingly I am of the view that there is already an effective agency which has the qualities of professionalism, independence and transparency for dealing with the grievances of VHI members as these relate to the application of the terms and conditions of their policies.
There is lack of public awareness that the insurance ombudsman is available to intervene, redress and make recommendations on conflicts between members of the VHI and VHI management. I am sure our debate this morning, together with the debate on Committee Stage, will receive publicity, which will increase awareness of the work of the insurance ombudsman. Under the VHI rules, which are available to all policyholders, there is a provision that any difference of opinion between the board and a subscriber may be referred to arbitration in accordance with law. That is an avenue through which the settlement of disputes can be further pursued.
The VHI moved rather quickly in the latter half of last year to set up the VHI Members Advisory Council. I think that move was motivated by the debate initiated by Deputy Geoghegan-Quinn on Second Stage. I am mindful that such a scheme is now in place. The council met on 19 January under the chairmanship of the Mr. Finbarr Flood of the Labour Court. It has 12 ordinary members drawn from different backgrounds. The VHI is not represented on the council.
For the information of Members I will outline the council's terms of reference: to review all communications with VHI members, including product terms, and to suggest ways in which these can be improved; to propose codes of good practice in all aspects of VHI business, including the standards of services required from hospitals and doctors; and to review such other aspects of VHI operations as are considered appropriate from time to time. It is also envisaged by the board that the terms of reference will be reviewed by the council in the light of experience. Accordingly the council has been given a wide remit with provision to further define its terms of reference, and that is to be welcomed.
Having regard to the functions of the insurance ombudsman, the council which will not deal with members' complaints and VHI documentation which will inform members about the board's participation in the ombudsman scheme, there is probably sufficient redress at present. It is apparent the VHI board has put considerable thought and effort into devising a forum through which the views of consumers may be channelled, articulated and focused. I accept its good intention and I hope the system works as intended.
I convey my wish to the board, if it is not already its intention, that annual reports should contain information about the work of the VHI Members Advisory Council so that transparency, which is very important, is evident. That would further encourage consumer confidence in the council. Under the 1957 Act the Minister for Health is obliged to lay the annual report and accounts of the VHI before each House of the Oireachtas. That provides a further element of accountability. The fact that I am increasing the size of the board weighs on the same side of the scales. There will be a wider representation on the board and in turn, taking into account the professions I indicated, a wider range of consumer experiences will be represented.
I share the Deputy's desire that the VHI should have independent redress. If the provisions I outlined this morning do not do that, I reserve the right to establish and legislate for a body independent of the VHI. This body would have the right to investigate complaints by persons availing or proposing to avail of a scheme referred to in section 2 of this Bill in relation to the board's performance of its functions. The right to investigate disputes between the board and such persons in relation to the performance of its functions will be appropriate, as will the furnishing of reports of the results of its investigations to the Minister, the board and the person concerned. If considered appropriate, it will also make available its report's recommendations arising out of its investigations, including recommendations designed to lead to improvement of the performance of the board's functions, and it will furnish an annual report of its activities to the Minister who may lay it before the House of the Oireachtas.
I have taken into account what the Deputy said, particularly on Committee Stage, and there is a lot of merit in her arguments. The measures in place are probably sufficient to meet the Deputy's requests. However, if there is a need for an independent body, depending on how this works out in 1996, I will provide it.
I appreciate the Minister's good intentions in this regard. I should have declared a personal interest in the VHI because I am one of its subscribers who has benefited considerably over the years. While my experience as a subscriber with the company has been a good one, that is not the case for everyone. The Minister accepts that. The independence given to the users' commission in this amendment is what the VHI membership requires. I appreciate that the VHI has a members' advisory council. I was not aware, until the Minister said it, that its reports will be included as part of the VHI's annual report. That is an important step forward.
It is important that subscribers should have confidence in whatever complaints procedure is in place. That is the case with the Broadcasting Complaints Commission and the Garda Síochána Complaints Board. While it is accurate to say that the VHI, in relation to the insurance ombudswoman, should be put on the same footing as other insurers, it is slightly different in that other insurers have active and aggressive competition in the market, whereas the VHI does not. It may take some time for it to have the type of aggressive competition in the health insurance market which we would like to see.
It is always better to give people an opportunity to voice their complaints in an independent way rather than encouraging them to take legal proceedings which are expensive for both sides. We must do everything we can to encourage people to have faith in an independent complaints procedure which will not go as far as a court, but will leave them satisfied that their complaint was examined. I agree with the Minister that the public should be made aware that subscribers who are aggrieved at their treatment by the VHI can raise it with the insurance ombudswoman. I accept what the Minister says that few subscribers to the VHI realise they can ask the insurance ombudswoman to investigate their case.
I am interested in the users' commission because one individual has written to me on numerous occasions about an ongoing battle with the VHI over a bill of almost £5,000. That subscriber was a managing director of a big company and is capable of making an argument and fighting his case. He is totally frustrated by the company and will not fight any more. He believes there should be an independent users' commission so that he and people like him will have the confidence to go before it.
Although the Minister does not recognise the need to include this in the Bill, he has given a commitment that if he is not happy with how the members' advisory council works, he may table an amendment to this Bill in the future. I have listened to the Minister's argument and I accept his intention to include it in the Bill at a later date. However, I will push this important amendment to a vote.
Amendment put.
The Dáil divided: Tá, 56; Níl, 71.
Tá
- Ahern, Bertie.
- Ahern, Dermot.
- Ahern, Noel.
- Aylward, Liam.
- Brennan, Matt.
- Brennan, Séamus.
- Briscoe, Ben.
- Browne, John (Wexford).
- Burke, Raphael P.
- Callely, Ivor.
- Clohessy, Peadar.
- Connolly, Ger.
- Coughlan, Mary.
- Cowen, Brian.
- Davern, Noel.
- Dempsey, Noel.
- de Valera, Síle.
- Fitzgerald, Liam.
- Foley, Denis.
- Geoghegan-Quinn, Máire.
- Haughey, Seán.
- Hilliard, Colm M.
- Jacob, Joe.
- Kenneally, Brendan.
- Keogh, Helen.
- Killeen, Tony.
- Kirk, Séamus.
- Kitt, Michael P.
- Kitt, Tom.
- Lawlor, Liam.
- Leonard, Jimmy.
- Martin, Micheál.
- McCreevy, Charlie.
- McDaid, James.
- McDowell, Michael.
- Moffatt, Tom.
- Morley, P. J.
- Moynihan, Donal.
- Nolan, M. J.
- O'Dea, Willie.
- O'Donnell, Liz.
- O'Donoghue, John.
- O'Hanlon, Rory.
- O'Keeffe, Batt.
- O'Keeffe, Ned.
- O'Leary, John.
- O'Rourke, Mary.
- Quill, Máirín.
- Ryan, Eoin.
- Smith, Brendan.
- Smith, Michael.
- Treacy, Noel.
- Wallace, Dan.
- Wallace, Mary.
- Walsh, Joe.
- Woods, Michael.
Níl
- Ahearn, Theresa.
- Allen, Bernard.
- Barrett, Seán.
- Barry, Peter.
- Bhamjee, Moosajee.
- Bruton, John.
- Bruton, Richard.
- Burton, Joan.
- Byrne, Eric.
- Carey, Donal.
- Connaughton, Paul.
- Connor, John.
- Costello, Joe.
- Coveney, Hugh.
- Crowley, Frank.
- Currie, Austin.
- Deasy, Austin.
- Deenihan, Jimmy.
- De Rossa, Proinsias.
- Doyle, Avril.
- Dukes, Alan M.
- Durkan, Bernard J.
- Ferris, Michael.
- Finucane, Michael.
- Fitzgerald, Brian.
- Fitzgerald, Frances.
- Flaherty, Mary.
- Gallagher, Pat.
- Gilmore, Eamon.
- Harte, Paddy.
- Higgins, Jim.
- Higgins, Michael D.
- Hogan, Philip.
- Howlin, Brendan.
- Kemmy, Jim.
- Boylan, Andrew.
- Bradford, Paul.
- Bhreathnach, Niamh.
- Broughan, Tommy.
- Browne, John (Carlow-Kilkenny).
- Kenny, Enda.
- Kenny, Seán.
- Lynch, Kathleen.
- McCormack, Pádraic.
- McDowell, Derek.
- McGahon, Brendan.
- McGinley, Dinny.
- McGrath, Paul.
- McManus, Liz.
- Mitchell, Gay.
- Mitchell, Jim.
- Nealon, Ted.
- Noonan, Michael (Limerick East).
- O'Keeffe, Jim.
- O'Shea, Brian.
- O'Sullivan, Toddy.
- Pattison, Séamus.
- Penrose, William.
- Quinn, Ruairí.
- Rabbitte, Pat.
- Ring, Michael.
- Ryan, John.
- Ryan, Seán.
- Sheehan, P. J.
- Shortall, Róisín.
- Stagg, Emmet.
- Taylor, Mervyn.
- Timmins, Godfrey.
- Upton, Pat.
- Walsh, Eamon.
- Yates, Ivan.
Tellers: Tá, Deputies D. Ahern and Callely; Níl, Deputies J. Higgins and B. Fitzgerald.
Amendment declared lost.
Bill reported with amendment and received for final consideration.
Question proposed: "That the Bill do now pass."
(Limerick East): I thank those Members who participated on Second, Committee and Report Stages, in particular, Deputy Geoghegan-Quinn who carried the debate this morning and, on Committee Stage, Deputies O'Malley and Michael McDowell, the latter represented his party this morning, when we appreciated his quietness and sense of reflection.
Question put and agreed to.