As this is a very comprehensive Bill amending and altering six existing Acts, I think it would help the House in the discussion of it if the Minister were to outline its main provisions.
National Health Insurance Bill, 1929—Second Stage.
Question proposed: That this Bill be read a second time.
The Bill is intended mainly to give effect to some of the recommendations of the Commission that was set up to go into the question of National Health Insurance. In the first place, there were persons called exempted persons. Though they were called exempted persons they were not exempted. They came in under the Act, but were exempted from paying contributions. Their employers and the State paid contributions, and these persons got certain benefits under the Act. They were exempted for the reason that they had a certain income of, I think, about £26 a year, or for the reason that they were dependent on some other person. The Commission recommended that they were a privileged class. They were a very small number. I think that at the moment the number is only about 700. We think that exempted persons should be done away with. They got certain privileges that were paid for. The cost of administering benefit to these people was out of all proportion to the number of persons involved and was without any advantage whatever to the system. Therefore, exempted persons are being done away with as recommended by the Commission.
With regard to deposit contributors, the number of them is between three thousand and four thousand. Deposit contributors are persons who are liable to be insured, but who do not join any approved society. They come under the head of deposit contributors and pay the usual contributions, but are only entitled to receive benefit to the extent of their own moneys paid in, plus the moneys the State pays in. They are being done away with under this Bill. There was a special arrangement in connection with migratory labourers by which they were exempt from the Act. Certain moneys that were paid in respect of them were not paid over to them in benefit, but actually were paid over to some nursing bodies in the West of Ireland. At the present moment there are only, I think, two persons who are claiming to be exempt as migratory labourers. We think that the circumstances out of which exemption in the case of migratory labourers arose have passed since about the year 1918 or earlier. There are certain small changes in the Bill by which the period for giving notice of sickness under the Bill is being extended from three days to seven days.
The major changes that the Bill covers relate to the abolition of insurance committees. Certain funds were made available under the National Health Insurance Act for the treatment of tuberculosis, and were paid over annually. They amounted to 1/3 per head of the insured persons, and were paid over to the insurance committees throughout the country for administration. The insurance committees as set up represented the county council, the approved societies which represented the insured persons and the Insurance Commission. The money was handed over to the insurance committees and was administered by them. With the exception of about five counties, these insurance committees have entered into arrangements with the county councils or the boards of health by which the moneys that used to come over to the insurance committees are transferred to the boards of health bodily. Insured persons looking for sanatorium treatment are recommended by the insurance committees to the boards of health, and are dealt with under the ordinary county schemes. These insurance committees will also deal with such matters as had to be dealt with in respect of deposit contributors. The machinery generally for dealing with tuberculosis throughout the country has been very considerably increased during the last few years. In fact the amount of money that has been spent on insured persons is greater than the amount of money that has actually been paid over to the insurance committees. The committees, in many instances, find themselves in the position that the amount of money at their disposal is not sufficient to cover the number of insured persons who are looking for sanatorium treatment. The general position is that sanatorium benefit, which was in the Insurance Act originally, was dropped in England because it was not adequately provided for in the finances of the Act. It is proposed to drop that here now.
At the present moment the amount paid annually to the insurance committees is about £27,000. It is proposed under this Bill that there should be a State contribution of £27,000 made to the local bodies over and above the 50 per cent. contribution payable to them in respect of their total expenditure on tuberculosis schemes. That £27,000 will be available, and will be spent on tuberculosis treatment for insured persons. Under the agreements that have been made between the insurance committees and the county councils a certain proportion of that will be for sanatorium treatment, a certain proportion of it for domicilary treatment and, generally, medical treatment, but as far as expenditure by the local bodies is concerned the same proportion will stand. Until that amount has been totally spent, no person who can give evidence of being a member of an approved society will be charged for tuberculosis treatment, so that we are ensuring that, while doing away with the insurance committees, the amount of money that has been available for free treatment for insured persons up to the present moment will continue to be available. There has been a very large increase in the amount expended on tuberculosis treatment. It has increased from about £30,000 a year in 1922 up to approximately £110,000 in the current year. Therefore, the amount of money generally available through public sources for tuberculosis treatment is going to be very much increased. We are making the change at a time when there will be no loss of benefit to anyone entitled to sanatorium treatment and who had it before.
Another important change that has been made relates to medical certification. Because of political and general circumstances of the country, it came to be left entirely outside the scope of the finances of our National Health Insurance scheme. The State annually passes a sum of approximately £34,000 for medical certification. As I have said, we are taking out sanatoria benefit, but medical certification is now being put into the finances of the scheme. In future, the National Health Insurance scheme will have to bear the cost of medical certification. That is covered by relieving the National Health finances of the amount of money that is to go for tuberculosis treatment. The amount of money that will go for that will be £27,000. That money will be voted separately by the State for that purpose. As I have said, it will be entirely outside the finances of the National Health Insurance scheme.
The next important change is with regard to the position of married women. Under the National Health Insurance scheme the present position is: a person who, within twelve months after her marriage, or eight weeks immediately before her marriage, is for eight weeks unemployed, or by reason of sickness is for eight weeks continuously in a state of ill-health, comes into what is called the K Class. She becomes no longer entitled to ordinary benefit, but she simply becomes entitled to this, that during the next ensuing two years she will be paid benefit to the extent of 7/6 per week for eight weeks in the case of ill-health. She will have certain rights with regard to sanatorium benefit inside a period of two years, and she will get a gratuity on the occasion of her first confinement inside of two years. It is proposed to change the position of married women and to bring about this position: that when a woman who is an employed person marries she ceases to be an insured person. She will get on her marriage a gratuity which will be actuarially figured out. If a woman who is an insured person marries, and then comes into employment again, and as a result of that into insurance again, she must restart as an insured person. There is just that special provision by which, in the first year of her married life, she will not be allowed to enter into any scheme which may exist at the moment by paying up certain arrears in order to come into benefit. The actuary has pointed out that a married woman in the first year of her married life is not a normal person, so far as the National Health Insurance scheme is concerned. The scheme is liable to risks in the case of a person like that, and ought to be safeguarded against. The position, therefore, is this: that if a married woman, immediately after marriage, becomes employed again, she can work up her ordinary benefit and become entitled to benefit in the ordinary way. But in the period of twelve months after her marriage she cannot get that special type of consideration by paying up any amount of arrears that may be due, in order to get into benefit in the way that another person would be allowed to do.
The Bill, as I have pointed out, provides that no longer will there be exempted persons and no longer will there be deposit contributors. At the present moment approved societies have the power to refuse to take in insured persons into their societies. As a result of doing away with exempted persons and deposit contributors, we will have to make arrangements so that approved societies will not be able to refuse persons in the future, except in certain circumstances, in which it can be proved that the person ought not to be allowed to enter into insurance. The deposit contributors will be given an opportunity of joining within three months the particular society which they desire to join. If the deposit contributors have not elected to join a particular society within that period, they will be assigned by the Insurance Commissioners to some particular society or societies chosen by the Insurance Commission. The Bill makes certain arrangements with regard to other classes of insured persons, as regards military service particularly. Provision will be made for persons who may be called up for training on the reserve.
I think these are the principal matters touched on in the Bill. Perhaps I should say that the Commission drew attention to the fact that the large number of approved societies was contrary to conserving effectively the funds put into National Health Insurance schemes. In the discussion on the Bill that took place in the Dáil I undertook to introduce next year a measure which will enable a number of approved societies to be reduced. They have already been reduced pretty considerably within the last two or three years—that is, since the Commission reported. A reduction to an appreciably smaller number is desirable. While that recommendation of the Commission has not been touched on in this Bill, I hope to introduce a proposal dealing with it some time next year.
The Minister, as I understood him, intends to provide that girls when they are about to get married will cease to be insured persons. I understood him to say that they would get a sum at the time of their marriage that will represent the actuarial value of the contributions which they had paid in. He went on to say that during the twelve months after their marriage they will not be insurable. He was very frank in stating the reason for that, that from the actuarial point of view the risk would be too great. What I want to know is whether the loss would be so great as to make it worth while to introduce special legislation of this kind. Even if the risk is so great that married women should be excluded, I suggest for the consideration of the House that there is something small in a provision of that kind.
I think the Senator misunderstands. They will be able to start again. After their marriage, they are given a certain gratuity. If they continue in their employment or enter into employment shortly after marriage they can become insured persons again. There has been a system by which persons who have in fact made a certain amount of national health insurance payments and fell short of the statutory limits for benefits and thereby fell into arrears were within certain limits given an opportunity of paying up the arrears in order to come into benefit. The only discrimination against married women in these circumstances is that they are not allowed to become voluntary contributors. They are not allowed, inside the first twelve months after their marriage, to pay up what are purely arrears.
So as to come into benefit. I think that at first sight the Seanad would be against that provision, because in the first year of a woman's married life she certainly incurs great risks. These, however, are risks which people consider are of advantage to the State, and for that reason I would suggest to the Minister and for the consideration of the House that there is no need for special legislation in that regard. I certainly think that the reason which was very frankly given by the Minister is not sufficient for the introduction of such a provision in the Bill, namely, that the risk is too great, and that married women in general would be likely to get more out of the fund than they pay into it. That is the only objection that I have at the present stage to the statement made by the Minister.
Speaking with some knowledge of National Health Insurance, I must say that I am in agreement with the general provisions of this Bill. I think the Bill is an attempt to tighten up the loose joints in the existing Acts. With regard to the particular point mentioned by Senator Comyn, I think if the Senator understood the actual position he would not be found in opposition to the proposal with regard to newly married women. If a woman who is an insured person gets married, then she ceases to be an insured person if she does not continue to follow her ordinary occupation. In nine cases out of ten that type of insured contributor who gets married would be safeguarded, for the purpose Senator Comyn has in mind, by the husband. Speaking generally, a woman who is an insured contributor under the National Health Insurance scheme gets married to an insured person, and the husband's insurance will cover what Senator Comyn has in mind. The important fact that must be borne in mind is that the money is contributed just the same as a contribution to a trade union for the purpose of unemployment benefit. The money in that pool belongs to the members, and it must be properly administered for the benefit of the members as a whole.
No special privileges must be given to anybody, and the funds must be managed in the most efficient way, so that the greatest possible benefit will be given out of them. With regard to the wiping out of insurance committees, I am entirely in favour of that. As the Minister has pointed out, there is a certain sum of money available each year for the purpose of free sanatorium treatment for insured people suffering from tuberculosis. The whole of the money will now be available for the treatment of insured people suffering from tuberculosis, and the cost of running the committees will be wiped out. While there may be some things in the Bill with which I do not agree, I am, as I said, entirely in favour of its general principles.
On a point of explanation, I understood from the Minister, and in reading through the Bill the impression I also got was, that whether a married woman continues in the same employment or not, she is not entitled to be insured and to get full benefit in the first year.
She is entitled to be insured, but she starts as an insured person again, and what is not allowed to happen is that she cannot go into pseudo-employment for three weeks and get three stamps on her card, and then pay up the rest of the stamps herself as arrears and come automatically into benefit.
She cannot continue as an insured person.
No, she cannot continue. She may enter as an insured person, but she is denied for one year of her married life the type of privileges allowed to certain persons in paying up arrears.
There is no gap, as I understand it, if she goes on working after her marriage. This is only to deal with the case of arrears due at the date of her marriage.
The arrears must accrue after her marriage. If the arrears had already accrued that will affect the gratuity she will get.
Cathaoirleach
Her gratuity will absorb her contributions.
Question put and agreed to.
Committee Stage ordered for Wednesday, 18th December.
May I say that this is one of the Bills it will be essential to get finished before the end of the year?
Cathaoirleach
If notice of motion to suspend Standing Orders is given in regard to the Bill it will enable us to finish it in time.
Is it not absurd to get from the Dáil after it has adjourned a Bill which must be passed by the end of the year? If an amendment is passed here it will mean holding up the Bill.
If an amendment is inserted in the Bill it will be necessary to recall the Dáil. If I do not get the Bill this year I will have to deal with certain things that must be covered by this Bill or another Bill, such as medical certification, before the end of the year.
All I wanted is the assurance of the Minister that if necessary the Dáil will be called together.