Health Insurance (Amendment) Bill 2024: Second Stage

Minister for Health (Deputy Stephen Donnelly)

I move: "That the Bill be now read a Second Time."

This is an annual technical Bill regarding health insurance. However, there is a crucial difference this year in that I propose to make amendments to the Bill in the House in the coming hour or two which will create the legal framework for the provision of free hormone replacement therapy in Ireland for the first time. We are liberally using the legislative tools available to us.

Before we get to that, I must of course address the health insurance aspects of the Bill, namely concerning the risk equalisation scheme. Health insurance coverage stands at 47% of the population. This is 2.5 million people and represents a total annual premium income of €3.2 billion. Health insurance in Ireland is provided according to four principles: open enrolment, lifetime cover, minimum benefit and community rating. Unlike a risk-rated market, in a community-rated private health insurance market everyone pays the same price for a particular insurance policy. Insurers cannot take into account personal circumstances like health status or age. If they could, older and sicker people would have to pay a lot more for health insurance. The risk equalisation scheme is the mechanism designed to support our policy objective of a community-rated health insurance market. The stamp duty levies are collected by the Revenue Commissioners and transferred to the risk equalisation fund, which is administered by the Health Insurance Authority, HIA. The risk equalisation fund is designed to be Exchequer-neutral. The risk equalisation credits and stamp duty are updated on an annual basis. That is the main purpose of this annual Bill.

The HIA provided me with an annual report which analysed market data for the 12-month period from 1 July 2023 to 30 June 2024. This report recommended the risk equalisation credits, and the stamp duty levies required to fund them, to apply from 1 April next year. I have approved the risk equalisation credits to apply in 2025 and the Minister for Finance has approved the corresponding stamp duty levies. This year there will be no change to the hospital utilisation credit and the high-cost claim credit. The age-related health credit will increase for advanced policies and will decrease for most of the non-advanced policies.

In addition to the changes to the age-related health credits, this Bill will amend the definition of high-cost claims. High-cost claims arise in the Irish health insurance market where an insured person is extremely ill. They might attend hospital for an extended period. The claims are closely linked to very severe conditions and chronic conditions, such as cancer. The high-cost claims pool operates by compensating a portion - currently 45% - of a health insurance claim that exceeds a certain threshold. That threshold is currently €50,000 and applies within a calendar year. The remainder of the claim is covered by the insurer. The definition of a high-cost claim was to have included all HSE-approved drugs but it did not. An amendment to the definition, which is what we have here, is required to ensure the original broader policy intention is met.

I will now speak to the sections of this Bill. Section 1 defines the principal Act as the Health Insurance Act 1994.

Section 2 amends the definition of a high-cost claim to include a number of HSE-published lists of drugs and all drugs that are approved under the HSE drugs approval process. It also includes immunoglobulins, a group of drugs that were approved prior to the establishment of the current HSE drugs approval process in 2013. The revised definition will apply from the date of the introduction of the high-cost claim credit, 1 April 2022. This will ensure the State remains in compliance with the European Commission's approval of the risk equalisation scheme.

Section 3 amends section 11C of the principal Act to provide for 1 April 2025 as the effective date for revised credits payable from the risk equalisation fund.

Section 4 replaces table 2 in Schedule 4 to the principal Act. This table revises the applicable age-related health credits payable from the risk equalisation fund. The amounts are applicable on or after 1 April 2025. The amount of the credit depends on the person’s age and sex and on whether they have advanced or non-advanced cover. Non-advanced contracts provide for mostly public hospital cover, while advanced contracts provide a higher level of cover, including cover in private hospitals. Age-related health credits for advanced products will increase for all ages and genders. This is to meet the expected increase in claims in these segments of the market. Most of the age-related health credits will decrease for non-advanced products for all ages and genders. It is expected that there will be a reduction in claims for these segments of the market.

Section 5 amends section 125A of the Stamp Duties Consolidation Act 1999 to specify the applicable stamp duty rates to apply in the market for 2025. The stamp duty payable on non-advanced health insurance contracts will decrease from 1 April 2025. It will be €94 per adult, a decrease of €11 from the current rates, and €31 per child, a decrease of €4.

On advanced health insurance contracts, the stamp duty will increase to be €469 per adult, which is an increase of €49 from 2024 rates and €156 per child, an increase of €16.

Section 6 provides for the Short Title, commencement, collective citation and construction of the Bill.

The risk equalisation approach is supported by the public. According to a 2021 survey by the HIA, nearly 80% of those surveyed agreed that premium prices should not be dictated by a person’s current health. The same survey confirmed that more than 70% agreed that older people should not be charged more for health insurance.

The approach is in line with the Government’s work in reducing the costs of healthcare for people across the board. In the lifetime of this Government, we abolished inpatient hospital charges. There was a cost of up to €800 for an individual, which could be at a time when somebody was very sick and already dealing with a lot of different issues. We have rolled out free contraception up to the age of 35. We expanded access to free GP care to an extra 500,000 people, including children up to the age of eight. We introduced fully State-funded assisted human reproduction or free IVF. We reduced the drug payment threshold significantly to €80. That is the maximum amount any family would pay for medicines in any given month. We also fully paid for the costs of diagnostics where GPs are referring their patients - hundreds of thousands of patents - be it for X-ray, MRI, DXA, ultrasound or CT scans. These are now fully paid for by the State. Critically, those patients get to go back to the GP, so there is a benefit to the patient and the GPs are very happy that they do not lose their patients to an outpatient waiting list. They can bring their patients back and continue with their treatment of them. Most recently, I allocated funding for the provision of free HRT. I very much look forward to discussing that in more detail when I bring forward the Committee Stage amendments shortly.

Deputy David Cullinane

This is an annual Bill to review the risk equalisation mechanism that supports the community-based health service insurance market. It revises the stamp duty levy on policies and the risk equalisation credits payable to insurers for 2025. Risk equalisation as a principle ensures that costs are constant across the lifespan of the individual. It seeks to ensure, where possible, that age, gender and health status do not influence the cost of an insurance product. This legislation is required each year to revise the system of credits and levies to ensure the risk equalisation scheme operates in a consistent and fair manner, while also generating sufficient income to ensure it is self-financing. Recognising the reliance of so many people on health insurance, we will be supporting the Bill, as we have done in previous years.

I will be tabling an amendment on Committee Stage to limit the reasonable profit for providers to 5%, which is similar to the rate of reasonable profit from 2016 to 2020 until for some reason, this Government increased it to 6% and higher. At a time when so many families are facing significant cost pressure, when premiums are rising because of runaway health inflation and when 47% of the population rely on private health insurance because of our failure to fix the health service, it is incumbent on private providers and insurers to do their bit to ensure affordability for ordinary workers and families. The high level of health insurance cover across the population - 47% - is in many ways a damning indictment of the Government's failure to deliver a single-tier public health service that is fit for purpose. As the Minister will know, many people take out private health insurance not because they want to but because they feel they have no choice.

At this point in my Second Stage contribution, I will talk about some of those issues. I recognise the advances that have been made and the measures the Minister has taken over the course of the last five years in a range of areas. I recognise and accept that the abolition of inpatient hospital charges, for example, was a positive step forward and that the expansion of GP care and the provision of more free GP visit cards was important as well. However, I hope the Minister will accept that we are still a long way away from having a single-tier public health service that is free at the point of delivery - the health service that was promised in Sláintecare. There have not been any major changes to medical cards in a number of years. I hope that whoever is in and leading the next Government will see major reforms in that area. There are many people on low and medium incomes who should have access to and availability of a full medical card. We also have to do much more to reduce the cost of medicines, particularly prescription medicines. All of those must collectively and individually form part of what political parties will offer during the course of the election campaign for who might be in government next. We have to continue to take big, bold steps to reduce the cost of healthcare. That will in part reduce the pressure and reliance on people to take out private health insurance.

The biggest game-changer, if I were to look for one, and the biggest benefit of private health insurance at the moment is access to day-case elective planned procedures. That is probably the biggest advantage. If you have an emergency, you are going to more than likely end up in a public hospital if it is a trauma or a heart attack. That is most likely where you will end up getting treated. The benefit for private health insurance does not exist there. Of course the State provides all those very costly specialist services, as it should. Many people have private health insurance because they feel they have no option or choice. The big benefit of private health insurance, as I see it as someone who does not have it, is in diagnostics, scopes, scans and planned procedures. There is a lot of profit in it because patients are in and out and done. That is where the scale and profit is. That is where the money is. That is why it is so important that the elective-only hospitals are built.

If we want to talk about reform with a big "R" in healthcare, it involves separating scheduled care from unscheduled care. In the public elective-only hospitals we are planning to build, people can get day procedures and planned procedures done very quickly and rapidly. This means they do not have to wait many years, in some cases, for access to very basic care. I have given the example a number of times, and I will repeat it again because it haunts me to this day, of when my own mam got sick with cancer. I brought her to a hospital in Waterford. I knew she was sick for some time. I knew there was something wrong. My family had an instinct, although I do not know if she did at that point. However, I brought her to the public hospital. She was brought to the emergency department, got a quick examination and was told that she would have to go on a waiting list for a scan that could take six months, a year or longer. A physician I know - a consultant working in the emergency department - pulled me to one side, said it would cost about €600 or whatever it was to get the scope in what is now UPMC Whitfield Hospital, and advised me to go and get it done. We took that advice and she got access within a week because the money was there. She was able to get the scan, and she was diagnosed with cancer. Unfortunately, she had to battle for a year and did not come through it. This is my point, however: why did she have to go to the private clinic? She got the care more quickly there, having been told she could be waiting six months or a year. We know rapid access to diagnostics is one of the reasons people take out private health insurance. Getting day case procedures is one of the reasons. My point is that if we really want to transform healthcare and have a single-tier public health service, which we all signed up to under Sláintecare, we have to deliver on those reforms.

While I am sure the Minister will defend his position robustly, I have to point out that we have not made the progress we should have made with the elective-only hospitals. I know that sites have been identified. In Dublin, maybe we are a bit further down the road than we were when we discussed this three or six months ago. It must be a top priority for the next Government. These areas are ones in which we can reduce the dependency on private health insurance. I do not want to be in a situation where we are coming here every year discussing a Bill like this, which I support because of the fact that so many people have private insurance. In reality, we know many people are struggling with the costs of childcare, fuel prices, groceries, the cost of living, paying a mortgage or rent and all those issues and on top of all of that, they have to take out private health insurance, as they see it. They do not believe they have any choice because they want to protect their families.

We also know, and it is a product of the failure in the healthcare system as well, that children who have a disability are paying for private assessments of need. Parents of children with disabilities are paying for therapies privately because they cannot get access to those services publicly through the HSE because of failures in these areas. Even though we are spending a lot of money in healthcare - €24 billion this year - people look at all of that and it does not matter to them whether it is €10 billion, €20 billion or €50 billion.

What matters to them is whether they can get access to healthcare quickly and whether their child with a disability is getting the assessment of need that child deserves or getting the therapies that he or she needs. They want to know why their loved one is on a hospital trolley. They are asking why there are nearly 1 million people on some form of health waiting list? I heard some misinformation on waiting list in the course of the Dáil proceedings today, by the way, which I am happy to say was misinformation because long wait times have come down but we still have 800,000 people on some form of acute hospital waiting list when one looks at all of them. We also have far too many on community waiting lists, we have diagnostic waiting lists and there are hidden waiting lists in other areas as well. The point is there are far too many. Although, rightly, there was a concentration on reducing the number of long waiters, which I have fully accepted, I hope the Minister would also accept that, while some progress has been made, we have a long way to go.

It was done differently in Britain when, through an Act of Parliament, the NHS was brought into being and there was a single-tier health service. That is not without its challenges now. As we look at finishing the job in terms of Sláintecare, there are lots of examples around the world that we can look at, such as the Nordic countries, for example. We have to look at every country and look at the best and the worst of all the systems as we continue to make the progress we want to make.

I want to get to a point where we have a health system that is a single tier. There will always be private health insurance and private healthcare but there should be less of it, less profit in healthcare and more opportunities for people to access public healthcare in a timely fashion. Whether it is a child with scoliosis, a child with disabilities, an older person looking for home care or somebody who has a mental health challenge and cannot get access to mental health services when he or she needs it, all of these are areas where we need still more investment, more reform and more changes.

I will be supporting this Bill. As I said, I will speak to a number of amendments. Obviously, on Committee Stage, we will deal with the other issues that the Minister is bringing in as well, including the public scheme for HRT which, of course, I support. It will be massively important for women and I commend the Minister for bringing that in. It is really important.

Deputy Duncan Smith

The Labour Party will be supporting this legislation, as we have previously. Risk equalisation, which the Bill provides for annually, ensures costs will be constant across a lifespan for an individual. It seeks to ensure that, where possible, age, gender and health status will not influence the cost of an insurance product.

Let me be clear, though. Our support for this Bill is not an endorsement of the current two-tier system, where so many people are reliant on private health insurance for their basic health needs, with the cost burden that is attached to that. The level at which people are reliant on it is reflective of a wider problem that we all can see in our health system and which was acknowledged in the previous Dáil with the special committee which ultimately agreed Sláintecare.

We must ask why so many people find themselves with little option but to fork out substantial costs each month for private health insurance. The answer is obvious. It was discussed today on Leaders' Questions and, indeed, this morning, with the Labour Party's motion on healthcare staff.

Hospital waiting lists remain unacceptably long and patients are waiting months and years to receive care through the public system and facing long stretches of time in emergency departments. In short, many people do not have faith that the public system can meet their health needs. Decades of mismanagement of our health system have brought us to this point and the delivery of Sláintecare and its goals has slowed to a crawl.

Most people in the country who understand and are engaged with the health service are 100% behind Sláintecare. As Deputy Cullinane has stated, we have seen the benefits of a universal system with the NHS in the UK, although it is not without its problems now, as the Deputy recognised. People want to see Sláintecare delivered but are losing faith that this Government can do so. To be honest, I think the people are losing faith that any Government can do so effectively, and that is a challenge to us all. They do not see the required staffing levels coming through or the levels of student intake that are needed in our third level institutions. Of the students who are graduating, we are seeing too many go abroad to work. Instead, they see a Government that is struggling to fund the HSE and our health service adequately, given our population increase and the demands on such

The healthcare staff who are coming through and are deciding to stay and dedicate their careers to the Irish health service are struggling to afford to live in the country; they are struggling to afford safe and secure long-term housing, either through purchase or long-term rentals. The reality is we are not retaining enough of the people we are educating. We are having difficulty retaining anyone who is entering our health service at any level, either through FETAC or degree level.

Private health insurance, as I have stated, cannot become a synonym for good healthcare. However, this is quickly becoming the perception and, in some instances, a reality. There is a huge issue in communities all over the country whereby people facing mental health issues and parents of children with mental health issues are being told to go private due to the extensive waiting lists in the HSE. They then learn almost immediately that their private health insurance does not cover the particular service they require in the mental health sphere. Mental health is an issue this Government has not given due priority to. As I stated this morning, and to repeat what was said to me earlier this week by a retired mental health worker, it has remained the Cinderella of our healthcare system. Access to mental health services cannot be a choice between a long waiting list or a huge cost in the private sector. Unfortunately, that is where we are now.

What we need to see moving forward is a real end to the recruitment freeze, adequate funding of our health service and real actions to deliver Sláintecare - a healthcare system that would be truly valued and trusted by the people. If that is the case, we will see a natural reduction in the number of people who are reliant on private health insurance and, we hope, people will get the care they need through a first-class internationally respected public healthcare system. Unfortunately, we are not there yet. Hopefully, we will be some day.

Deputy Róisín Shortall

This is the annual practice of committing to the provisions of this legislation relating to the private health insurance market to provide for community rating and risk equalisation. It is a technical measure. In the context of a private health insurance market, it makes sense not to have cherry-picking by some of the newer entrants into the market or any kind of marketing to attract younger entrants where the demand for services would be lesser than for older existing policyholders. For that reason, it makes absolute sense. This is the technicality that we go through every year at this time. I have no difficulty with the provisions of this legislation insofar as they go but I will make a few points about this Bill.

Some 47% of people have private health insurance and the contribution that is made by those policyholders is valued at €3.2 billion. When one considers the total health spend this year will be close to €26 billion and nearly half the population is covered by private health insurance, the private health insurance premiums only make up a tiny fraction of the overall spend on health. It used be 15%; it is less now. It is a very small contribution, given that nearly half the population has private health insurance.

Private health insurance is very expensive. Last year, the average premium was €1,600. When one considers the number of people in the country who are contributing an average of €1,600 to private health insurance, yet the spend is so much more than that, the point is that the taxpayer is paying for the vast bulk of healthcare services to private and public patients. In recent years, and through Sláintecare, there has been an effort to untangle that. In many ways, because of the small contribution private health insurance makes to the overall health spend, that was considered in quite a bit of detail by the Committee on the Future of Healthcare. The committee looked at different funding models for a properly functioning Irish healthcare system and the conclusion reached by everybody on the committee was that the vast bulk of healthcare is being paid for through taxation, so why would one change from that system?

For that reason, we recommended a national health insurance type model, where tax receipts would fund the full health service. It is just important to bear that in mind. We have to ask where all this money is going. Is there not massive cross-subsidisation from the public purse to private patients? That is the reality of what is happening. In many ways the State is not getting very good value for the private health insurance providers.

Things are hopefully changing as a result of Sláintecare. A fair deal of progress is being made and has been made in recent years even though it had an exceptionally slow start in terms of implementation. Of course, we still have a very long way to go. Sláintecare is the cross-party agreed policy for all parties and independents here in the Dáil. It is disappointing that seven years in there is still such a long way to go. I call on all parties facing into the upcoming election to commit to fully funding Sláintecare within the term of the next Government, not merely paying lip service to that, and that there would be a commitment to pre-committing the necessary funding each year. Every year in the budget, money is pre-committed for the national development plan or the public pay agreement. It should also be pre-committed for the full implementation of Sláintecare. Parties should consider doing that. It would be an important thing in the interests of the State and all our citizens if we did this. It has the potential to be transformational in terms of people's lives because of the speedy access to healthcare that could be possible, resulting in much better quality of life and indeed saving lives over the coming years. We are so out of line with what is happening in the rest of Europe. In the main, citizens in European countries take it as a given that they have access to a universal healthcare system. There are different ways of funding it but it is a given. The idea of paying to see a GP or paying through the nose to see a consultant is just unheard of in most other European countries. We have a long way to go.

I want to talk about a number of those areas where progress is slow. I will recognise the progress that has been made but still we have a distance to go in removing cost as a barrier to access to healthcare. We have seen improvements over the last few budgets but there is still a lot to be done in that regard. An awful lot of people have to pay the full cost of €60 or €65 to see a GP. As I said already, there is then the significant cost of accessing a consultant. There is also the cost of medicines, of course. That needs a two-pronged approach in my view. We need to be negotiating with the pharmaceutical industry in a thorough and robust way, which we have not been doing. The cost of medicines as a percentage of the spend on health is far too high in this country and much higher than in the UK, for example. Considering the strength of the pharmaceutical industry here, the very good deal they get tax-wise and the very good operations they have thanks to the Irish education system, it is just not good enough that they are screwing us over in terms of the cost of medicines. I have often thought that the approach by the Department of Health is not a very clever one when it comes to negotiating price with the pharmaceutical industry. In commercial terms, these are sharks that come in. There are billions of euro at stake here, yet we do not have professional negotiators negotiating decent prices. That needs to be dealt with.

On re-orienting the health service to the community, we are still far too hospital-centric. In order to re-orientate fully we have to have adequate capacity at primary care level. That capacity just is not there. We are on the way but it is certainly not there yet. We need to take new approaches. For example, there is a serious shortage of GPs. While we can train more, the reality is that more of them will go abroad and work in other systems that function better than ours. I will say again to you, Minister, you need to consider the proposal to have salaried GPs. There are lots of GPs who want to work in the Irish healthcare system. They do not want to be business people. They want good work-life balance. That certainly will not be achieved under the present contract. The way to achieve it is by having salaried GPs or different partnerships. I have been talking to the Minister about a charity, GPCareForAll, which looks like being lost now through inaction on the part of the Department of Finance.

I also want to talk very briefly about the importance of the legislative proposals in Sláintecare. It recommends legislation on a number of different areas. The first is on the need for a legal right to healthcare. Unlike social welfare, for example, there is no legal right to healthcare. We have this daft thing of eligibility. You are eligible if the service is there but it is tough if the service is not there. We need to legislate for a legal right to healthcare. We also need to legislate for accountability from ministerial level down to the regions at clinical and administrative level. That is a key part of establishing accountability in the culture or changing the culture to establish accountability across the board in respect of healthcare.

I repeat my concern about the drift in the health service in respect of over-outsourcing of so many different services, which is essentially the privatisation and financialisation of the health service. The Minister needs to stop that.

An Ceann Comhairle

Deputy Cathal Crowe is next.

Deputy Cathal Crowe

My apologies, I thought I was the speaker after next. I was tuned into something different. My sincerest apologies.

An Ceann Comhairle

So did I but my monitor is telling me something else now.

Deputy Cathal Crowe

A Cheann Comhairle, thanks for calling me to speak. Like other Deputies I welcome the Bill. This is one of those pieces of legislation each year that is up there with the Social Welfare Bill and the Finance Bill. It is very important. It needs to go through the Houses. It is about ensuring that older people in society will end up with insurance cover, that there is risk equalisation, that it all works out and all things are equal. I want to join with the sentiments expressed by others. I hope this will not be too convoluted a Bill and that it will pass through without any great debate or inconvenience in terms of amendments and whatnot.

Access to healthcare is what I would like to speak to in the few minutes I have. The Minister has often heard me speak about healthcare in the mid-west in this Chamber and in the health committee. As this Dáil enters its eleventh hour, it is a fact that the Minister has done a significant amount to address the inadequacies of healthcare in the mid-west region. There was yet another programme last night about UHL. The previous week there was the very upsetting "Prime Time" special about Aoife Johnston losing her life in UHL two years ago. There is a litany of evidence that points to under-investment and a hollowing out of the health system. To be fair, in his tenure, the Minister has tried to address it with 1,200 additional staff, a huge amount of funding, these new beds coming on-stream and equal investments happening in the satellite hospitals of Ennis, Nenagh and St. John's. That is all to be commended. The Minister has given the reasons many times as to why it is a bit more complex, but I would really love to put my view on record in this Dáil in respect of the HIQA review on a model 3 hospital or new accident and emergency department in the region. If more impetus can be given for that review to report back earlier than scheduled, it would be greatly appreciated in the mid-west region. In terms of healthcare we have been second-class citizens for too long. Things are starting to come right yet there is an elephant in the room, or rather an elephant missing from the room, namely a model 3 hospital in my home country of Clare. I hope that can be advanced somewhat. As we all pack up our bags in the coming weeks to go campaigning, I hope one of the Minister's parting shots in the Department will be to tell the officials and particularly HIQA to move on with that study and analysis and to report back more quickly than planned.

There was a very positive announcement last week by the Minister for further and higher education, Deputy Patrick O'Donovan. We are seeing new pathways into medicine, particularly at undergraduate level, with a focus on rural GP care being led out of NUI Galway. This is fantastic but I think we have to go one step further. Maybe that is a controversial view.

It is probably too late to happen in this Dáil but certainly when the next Government and Dáil are formed, I hope some negotiation will be held with the INMO, the nursing union, and the IMO, the doctors' union, in order that the best and brightest graduates we are churning out from our universities will remain on Irish soil for some period after graduating. I think it should be the carrot rather than the stick approach. They are young people and they have housing and cost-of-living needs. Maybe there could be some incentive to ensure our doctors and nurses will not end up in Melbourne, Dubai or Abu Dhabi for two or three years but will instead be in our hospital networks and provide rural GP care. I would love to see the Minister lead on some of that.

This may be one of our final debates on healthcare before the Dáil rises, whenever that does happen. I thank the Minister for what he has done in his Department and I hope there are a lot more positives to come. As I said, it would be major if that HIQA report could be moved on.

Deputy Ruairí Ó Murchú

It looks as though we will have a good deal of agreement on support for this legislation. We have spoken about the need for amendments but there has been some failure. As an example, yesterday I visited Clan na Gael's GAA club near Cox's Demesne in Dundalk, where there was a group called Maxi's Law, which is named after the unfortunate death by suicide of Mark “Maxi” Kavanagh, who was very well known in Dundalk. The group raised the issue of mental health services. People spoke about the need for equality of access and highlighted examples where, because they had cover with VHI or another provider, they were able to access St. John of God's, for example, or other services, which were not necessarily available to others, and the obstacles as regards due diagnosis and so on.

I have spoken previously about the fact we do not have adequate staffing in Louth-Meath mental health services. Crosslanes is due a ten-bed extension, which, along with resources, is absolutely required. We do not have a decent means of assessment for those resources, which needs to be sorted for both Crosslanes and Our Lady of Lourdes Hospital. There is obviously an issue with respect to emergency departments at the moment, which is why many of us attended the protest last Thursday. I have previously raised the issue relating to CAMHS in north Louth and anybody who has been listening to me over the past two weeks will have heard me relay the message stating that CAMHS in north Louth is experiencing a crisis in administration because the number of its administrators has been cut. There is only one person working, for three days a week, and calls are answered only between 10 a.m. and 12 noon on Mondays and Fridays. The message goes on to say clinicians will try to continue with their appointments and will answer the door for appointments, but that is all. While they are trying to do that, they believe that certain functions will be compromised. We have a huge issue and it needs to be addressed. I could go on.

Deputy Richard Boyd Barrett

"Laya profits soar to €36.55 million". That was a headline in the newspapers earlier this year. Its profits were up by €14 million. For AXA, I do not have the figure for its profits, but it had €2 billion coming in from premiums. It has 30% of the Irish market, while Laya has 28%, and I think AXA is now underwriting Laya premiums. This is big business and big profits, and those profits are generated through the fear that about 50% of working people in this country have regarding what will happen to them if they get sick and have to rely on the public health service. They know that if they have to rely on the public service, the chances are they will be on a waiting list. The chances are they may have to wait for considerable periods, maybe dangerously long periods, for procedures to alleviate their illness or pain, with all the fear and anxiety that goes with waiting for diagnosis and treatment. It is not because people want to pay out €1,600 or a couple of thousand euro a year in insurance. It is out of fear of the inadequate resourcing, staffing, capacity and funding of the public health service that they are driven to private health insurance, and then the private health insurance companies clean up.

That is what all this is about. The risk equalisation that we carry out every year with this Bill is a measure to somewhat ameliorate the profit-grabbing in order that there will not be wild disparities in the premiums that might be charged by these mostly profit-driven companies based on the age a person happens to be or on his or her state of health, although let us remember the reason we have to do this is that if we did not, they would rip us off even more. They would take even more money off us. Of course, we know about the consequences of this in countries such as the United States, where there is a full-blown two-tier system, as opposed to our two-tier health system that has been slightly mitigated. They spend more on health than any other country in the world does, but vast numbers of people have no health cover at all, because if you do not have the money, you do not get the healthcare. It is as simple as that. We are on that trajectory. In the United States, people are in a sorry state if they do not have the money to pay these profit-driven companies to provide them with healthcare when they get sick, are vulnerable or old or have a disability.

To my mind, the whole operation is pretty disgusting and we need to move rapidly away from it. Of course, it is self-perpetuating. The Government says it is committed to a single-tier system and that it wants to get rid of this with Sláintecare. How long ago did we all commit to that, with not a bit of serious movement towards it? The private healthcare providers are fully entrenched. Briefly, during Covid, when we had to because some of us were screaming at the Government to do it and because of the scale of the emergency, for a brief moment the State took over the private healthcare capacity because we had to have a single-tier response to Covid. Instead of moving on from that to take that private capacity as part of a single-tier health system and use the capacity of the private system to alleviate the crisis that exists in our public system, we gave it back to the providers in order that they could make more profits and in order that Larry Goodman, who owns the Blackrock Clinic, and all the rest of them could make more money out of it. Good old Larry, who moves from animal meat to human meat and makes a lot of money out of it, as do many others.

I find it quite revolting, and I do not think there is any serious intent by the Government to address this or to provide healthcare to everybody, regardless, on the basis of their health needs. That is what a decent and humane system would do. It would adequately resource this. Of course, the members of the Government will shake their heads and say this is not true, but the Government’s failure to properly staff and resource the public health system is, whether consciously or unconsciously, part of creating the conditions that allow the private healthcare companies to make a profit. The Minister will, of course, deny this and say the Government is saying to recruit people. We had this debate earlier, when I brought it up during Leaders' Questions, and members of the Government shook their heads and said the Government is not gaslighting the public but is really trying to recruit people, that there is no embargo.

I asked for further figures for St. Michael's Hospital and got a reply only after that debate. I wish I had had it during the debate. I got another answer about St. Michael's, my local hospital. I had asked the Minister for Health to confirm the number of staff who were on maternity leave at St. Michael's Hospital and whether cover would be provided.

The answer was that there were six staff on maternity leave, two senior physiotherapists, three enhanced nurse grades and one management administration grade 6. It was said maternity leave could not be provided within the hospital's current financial and employment control limits. It was made absolutely clear. With the pay and numbers strategy, it was not getting the staff to cover the maternity leave, and if that meant it did not have the nurses on the wards or the physiotherapists for the people who needed them, then it was tough luck on the patients and on the rest of the staff who were left to pick up the pieces as a consequence. That is repeated in hospital after hospital on a far bigger scale than St. Michael's Hospital, which is a relatively small hospital in my area. Is it any wonder that in that situation people would say they have to go to the Blackrock Clinic.

An interesting point was made to me by one of the St. Michael's healthcare workers and by a guy who worked in recruitment for the agencies and was part of the private thing. He asked why it is, when the Government says it is trying to recruit people into the public health service, that it is able to recruit people from the agencies? The Government is trying so hard but it just cannot recruit people. We cannot get them for the permanent jobs in a hospital, which are decent, secure jobs, but we can get them from the agencies. The truth of it is that the Government is not trying to recruit them in many cases. In some cases, it is just policy not to cover people out on maternity leave. People who leave are not replaced because if the staff required to replace the person who leaves takes that hospital area over the quota, then it is just not getting them. That is it. As the radiation therapists explained to me, if people leave, they might get replaced but they might not if the ceiling has already been hit. Therefore, in their case, machines lie idle that would otherwise provide lifesaving treatment to people with cancer. What are you going to do? Very likely, you are going to go private if you are facing the prospect of a condition that might end your life. What choice have you got? This is if you have the resources, and if you do not, you are in a dark space.

I will provide another little example from St. Michael's, a small hospital in my area. I tabled a parliamentary question to ask the Minister if a CT scanner has been considered for installation in St. Michael's Hospital. The answer received was that a business case for a CT scanner had been submitted to the HSE in 2023 and an outcome was awaited. In 2023, a question was asked about a CT scanner.

Dáil Éireann debate - Wednesday, 23 Oct 2024

Health Insurance (Amendment) Bill 2024: Second Stage

Dáil Éireann debate -
Wednesday, 23 Oct 2024