May I raise an issue of concern?
Health Insurance (Amendment) Bill 2017 [Seanad]: Committee and Remaining Stages
Sections 1 to 7, inclusive, agreed to.
Title agreed to.
Bill reported without amendment.
If it is relevant to this.
I want to ask the Minister how it is that if one is taken into hospital tonight and does not have-----
Just give me one moment. There have been no amendments. The Bill has been reported without amendments. When is it proposed to take Report Stage?
Bill received for final consideration.
Question proposed: "That the Bill do now pass."
A person taken into hospital tonight will be charged €75 if he or she does not have VHI or a medical card. As soon as a person is in shape enough to sign his or her name if he or she has VHI or other health insurance, the health insurance company will charge over €800 a night for the same bed for the same patient. That is what is driving up the cost of health insurance. It has been highlighted to me several times. If a person does not have health insurance, the cost is €75 per night but the very minute a staff member goes into the room and gets the person to sign that he or she has health insurance, the health insurance company charges over €800. That is totally unfair and is driving up the cost of health insurance for ordinary people. It is unfair. It is daylight robbery. If the same bed only costs €75 in one instance, how is it fair that €800 is being charged for it? I want that looked into and dealt with because it has the country and the people who are paying for health insurance robbed. If their income allows, most people will pay for health insurance. It is going beyond their reach now because what is happening is totally unfair. The HSE has ordered it. There are five Ministers and Ministers of State in the Department of Health. I have highlighted this anomaly before. I want it dealt with because it has wrecked private health insurance for all those who try to access it. It is totally unfair.
I thank the Minister of State for receiving a very important deputation this morning on mental health services in Clonmel. I know it is not relevant but I want to take the opportunity to thank the Minister of State for the way he received the deputation and the interest and compassion he showed. I welcome his commitment to come and visit to see if we can rectify the situation and address the lack of mental health services in Tipperary.
I asked this question the last time we debated the Bill and the amendments to it. I asked about the situation when a person is brought into hospital after an accident or when a person has developed pneumonia. In such a situation, people, especially older people, are vulnerable and can be on trolleys. I jumped out of my seat the last time to demonstrate patients on trolleys with nurse managers shoving a form under them. I will not perform the same theatrics tonight. The Minister shook his head and said it is not happening but it is a widespread practice in public hospitals. Patients go in as a public patients. They are very sick, perhaps not fully compos mentis if they are very sick or have a fever, and are asked to sign a form. They would sign anything at such a time to get some pain relief and treatment or to try to get into a bed. They sign the form. It is not right. It is a shoddy and slippery practice. We would not do it in a normal business. We would not sign something without reading it. Sometimes we do but we should not. We are not allowed to read the form and then we are fleeced. One might be on a trolley for three nights, which happens regularly in my hospital in Clonmel, and in the mid-west and Limerick. A family could stay in the Gresham for the same amount people are charged for one night in hospital. It is €800 and they are on a trolley with no sleep. When a person is on a trolley there is no space and it is normally in a corridor. There is noise from machines and the traffic up and down of trolleys and nurses and doctors doing their jobs. There is also the noise of other admissions during the night. I would call it emotional terrorism.
Mr. O'Brien, the CEO of the HSE recently called people concerned about vaccines for children emotional terrorists. I am not commenting on the rights or wrongs of the vaccine. The emotional terrorism is taking place in emergency departments and on trolleys. There are vending machines running in the corridors. I have been in the hospital. Most of the time they do not have blankets or pillows and their families have to bring them in with them and neither do they have access to the equipment in the ward, such as drips. There is no space in my hospital in Clonmel in a narrow corridor. In a new hospital it is different. If a nurse or doctor is attending to a person on a trolley, nobody else can pass because there is not enough space. It is a fire hazard. I had occasion to call in the fire officer twice a couple of years ago such was the concern. It is a degradation and apart from the money issue, the treatment of patients is like emotional terrorism. One hears lack of sleep cited in the description of war crimes. We hear about people not being allowed to sleep because of noise and being interrupted but this is happening in hospitals. I am not blaming the nurses, doctors or attendants in the emergency departments. They are only doing their best. They do not have the space, facilities, equipment or wherewithal to deal with this issue.
Discharges are another problem. We are heading into Christmas now. I said this the last time. Most of those who work in hospitals, including those who work in backup administration will go off next Friday week or earlier. They will be at parties two nights that week and there will be no admissions organised until 5 January. There will be bedlam before we come back here whatever day we come back, whether it is 15 January or 18 January. It happens every year. As soon as Christmas Day comes it will happen because there will be no administration staff working, no discharges and no proper structure. Why can a skeleton staff not work over Christmas and organise things? It happens in every hospital in the country. It would not happen in the Mater Private or another private hospital. It would not happen in any of our businesses because we could not afford it. We would be out of business.
If the shopkeeper did not have milk and other products for the people to get messages the day after St. Stephen's Day, St. Stephen's Day or sometimes even on Christmas day now, they would not survive. There is disorganised chaos in the hospitals and it should be dealt with. They have the planning done for the Christmas week and most people are off. In America, Christmas Day is all people get off. Why do these staff in our hospitals have to be off for two weeks at Christmas? Consultants have already taken holidays and there are no rosters or anything organised. We are losing huge capacity. That is why when the surveys are done equipment, such CT scanners and so on, are at only 46% capacity usage.
We need more functionality and more output. We need more planning in these public hospitals. I am not blaming all the staff, but senior management and line management have to take responsibility. This happens in every hospital, as the Minister of State knows. There will be a skeleton staff and the rest are not back until 2 or 3 January. They then must start writing out to outpatients to come in again. They have to start the whole machine again. It is as if they let the furnace go down and it needs to be built up again slowly to get the whole thing going. It should not be happening but it happens every year.
To go back to health insurance, people and families are paying exorbitant prices for health insurance. I have a large family. We have moved our health insurance to different companies a couple of times. People get less and less cover for more and more money. Cá bhfuil an regulator? He or she is supposed to be doing a job, but that is not the case. We have regulators for everything in this country but the majority are not regulating anything - across the cement industry, across competition laws, everything. It is all regulators and no one being regulated. They and their staff are getting paid; why are they not looking at this insurance racket? If it looks like a racket, it is a racket.
People are put to the pin of their collars trying to pay insurance and then if they do not have this insurance they cannot get access to private treatment. When they have it and go into a public hospital, they are sleeping on trolleys and being charged exorbitant rates. A big family could stay in two or three rooms in the Shelbourne hotel for the price they pay to be stuck on a trolley in a hospital corridor. It is unacceptable and it goes on year-in year-out. Who will call a halt to it? When will it be halted? I ask the Minister of State for answers.
I too am grateful for the opportunity to speak on this. I thank the Minister of State for coming to Kerry recently to open an excellent new mental health facility in Deer Park Lodge in Killarney. I wish the management, staff and patients well in what the Minister of State said is an excellent modern facility fit for purpose for many decades into the future where people can live in the dignity they richly deserve. I thank him for coming to open that facility. He was very welcome.
The cost of health insurance is a major bill in the lives of individuals, elderly and families who are struggling but they pay it diligently to do their duty of taking care of their own health needs. However, as has been highlighted here there is a complete anomaly in how the HSE structures its charges. First, we have the issue of people, as soon as they get a bed in a hospital, being asked to sign up to the fair deal. Second, they are asked about their private health insurance. If they say they have that, it is just like adding on more noughts and instead of €100, the bill could be €1,000. It just does not make sense.
Somebody in the HSE has to tackle this. The pricing structure and what is charged for private versus public has to be looked at. I do not want to say anything that is wrong and I seek your direction in this regard, a Leas-Cheann Comhairle. The changes made in the costs border on being criminal. How can the same bed be as little as €75 and then all of a sudden be as high as €800? Surely there is something seriously wrong with that. If someone buys an item in a shop and it is priced at €4.99, it cannot change to €499 for someone else. That cannot happen. These people are purchasing their health care. They are purchasing the right to stay in a bed or have a room in a hospital. If the charge is €75, how can it change just because it is on the insurance and one of the health insurance companies is footing the bill? What is happening is outrageous.
I have raised this through parliamentary questions over the years. I have highlighted it here in the Dáil previously. I am not pointing my finger at the Minister of State or at any one in particular. However, the HSE should be made answer as to who decides the price structure can change so much just because it is covered by private health insurance. If the private health insurance providers are to be charged an enormous amount of money, they have to shove it on at the other end to their customers.
These are the people we are here to stand up for, to talk for and to highlight their concerns. We have young struggling families who are trying to pay their mortgages, to pay for child care and pay for their health care. They are worried about their health care. If a child falls and breaks an arm or has a sporting injury, they want that child to be on their health cover. They are paying through the nose for it and they are paying more than they should be paying simply because of the enormous costs being put on at the other side.
I would like this to be examined with a view to bringing normality to the charging structures in our hospitals.
I welcome the opportunity to speak on the Bill. For people who have health insurance, we hear on a regular basis that there is a threshold of €100 or €150 and after that the health insurance kicks in. When they arrive in a hospital they are asked to sign a form. The reasoning behind this needs to be looked at, even though it might be good for the person going into the hospital. There might be a lot of people in a public ward and they might be charged for semi-private or private. If we heard two or three people saying it, we might not take notice, but a good few people have been speaking about this.
On risk equalisation, some people have gone to different companies. People are moving from VHI to Laya and to all the other providers. Will this continue? We need health insurance for elderly people. With demographic changes in a few years' time, a large percentage of our people will be over 60. Risk equalisation obviously increases the price of health insurance cover.
During the recession people walked away from health insurance for a while but it is welcome to see them take it out again. We looked at the situation in the United States at one time and what people were paying for health insurance in that country was phenomenal. For what one would call average, not gold star, cover here families are paying exorbitant fees. When does the Minister of State believe the cost of health insurance will settle because if it continues to increase at the current rate, it will be out of the reach of many people. Unfortunately, a large number of people gave up their health insurance. Some have taken it up again but I am worried that there are people who are chancing it in that they do not have health insurance and are not entitled to a medical card. If something goes wrong with their health and they have to remain in hospital for a while, they would not be fit to pay some of the cost. The first thing hospitals get people to do when they are admitted is sign a form. As rightly explained earlier, one is vulnerable when being admitted to hospital. One is not running around the place when one goes in the door of a hospital. There is a bit of panic. It might be difficult to get through the accident and emergency department but, in fairness, once one is admitted a great service is provided. The problem is getting admitted.
If someone who has health cover needs an operation they will be able to get it done fairly quickly. I see that with people who need treatment for cataracts. Another problem involves people who need scans. I know of someone who had a medical card and was told that they would have to wait six months for a scan but if they paid for it they would be through the system in a week. That is not the way to look after patients.
I refer to some people with health cover who are admitted to a public hospital, perhaps on a trolley, but in terms of the rates they are charged, one would swear they were in the best hotel in the world. Everyone will acknowledge that the doctors and nurses do great work. However, in terms of these people who are paying health insurance, some hospitals - I cannot talk about every hospital - may be abusing the type of cover that allows them to get in more money. They have to get what they are entitled to or whatever but some hospitals will do that.
Another issue came up in the HSE west in the Saolta Hospital Group. We were at a meeting in Galway and there appears to be a problem in drawing down money. I believe approximately €6 million or €7 million was not recouped by the Saolta Hospital Group or it was finding it difficult to recoup it. The financial controller said it does not write that off but goes after it. However, it seems to be struggling to get it. Is it the case that people are paying health insurance but there is then a big battle between the health insurance companies and the hospitals to cover their bills? Some of the prices charged for a night in a hospital for a minor operation are phenomenal. Is there any adjudication body, similar to the Taxing Master in the Four Courts, that examines that because the costs seem to be only going up? If that continues, health insurance will be out of the reach of most people because many people currently struggle to pay it. We need to be mindful of that and keep an eye on it to make sure that the problems and abuses we hear from people are addressed.
Does the Minister of State want to respond to relevant questions?
The purpose of the Bill is to specify the revised risk equalisation credits and corresponding stamp duty levies to apply on health insurance policies from April 2018. The Minister is pleased that this year it has been possible to maintain the main stamp duty at the existing level. In addition, the stamp duty for non-advanced contracts is being reduced by 20%.
The Bill also makes a number of changes to the lifetime community rating scheme in operation in the health insurance market which was introduced in 2015 to encourage people to take out insurance at younger ages.
Many of the questions asked of me were outside the scope of the Bill. The Bill does not purport to deal with the issues the Deputies raised. The two-tier health system and the challenges in the health system are beyond the scope of this Bill and this debate.
To answer the questions on health insurance, the Health (Amendment) Act 2013 was brought in to rectify the situation where some private work was being paid for out of the public purse. That is the reason for the forms that somebody said were being waved in front of patients. The private insurance patient, PIP, forms were introduced at the request of the health insurers. That came in as a result of the Health (Amendment) Act 2013, which prohibits funding from the public sector going towards the private sector.
The last point I would like to make is on the difference between €75 and €800. Obviously, no bed in a hospital staffed by nurses and doctors cost €75. The public purse pays for that and the €800 is what the health insurer has to pay for it. That is that anomaly.
Question put and agreed to.
A message will be sent to the Seanad acquainting it accordingly.