I move amendment No. 1:
In page 3, before section 2, to insert the following new section:
"2.-It shall be a function of the Health Insurance Authority to consider and report to the Houses of the Oireachtas on the extension of health insurance to the whole population with the objective of creating quality of care.".
The word "quality" should read "equality".
I welcome the changes proposed by the Minister by way of amendment in relation to the area of general practice and out patient services. The Bill has been improved considerably. The integration of primary and secondary care is an important part of health reform but it must be matched by a recognition that the two-tier system creates grave inequality and will have to be addressed. I do not wish to dwell on the unfairness aspect as we have had that debate on other occasions. However, I am concerned at the argument that the current system of private health insurance is unstable. I support the setting up of the Health Insurance Authority to ensure proper regulation of the market. When established it should consider the future of that market, changes occurring in the market and dangers occurring in the market. The Labour Party put forward its position on universal health insurance. I do not intend to go into that now except to say that health insurance is part of the solution rather than part of the problem as regards our two tier system.
The Minister for Health and Children has argued that he wants to build up the capacity of the public hospital service. I have no problem with that but the reality is that that will have an increased impact on the instability of the private health market. If the Government remains committed, as the Minister's predecessor declared, to charging the real cost of beds in public hospitals to private patients, that will create further impact on the private health insurance area.
Almost 50% of the population are taking out private health insurance but it has been reckoned that 11% of those cannot afford to do so. If the public service is expanded and improves in terms of its capacity to respond, many of the young healthy people who are crucial to ensuring that stability is maintained in the market, that community rating can work and that risk equalisation is part of the controls, may decide not to get involved on a voluntary basis in health insurance. If that decision is made as a consequence of Government policy, greater investment, etc., what impact will it have on the market?
The regulatory authority is possibly a good expert group in terms of assessing the changes and the dangers in terms of the market. The White Paper makes that point. It states that the future viability of community rating in a voluntary environment is dependent on people joining the private health insurance system at a young age. Huge numbers currently join, not because they are attracted to the idea but because they believe they need it to get quality care. If it is the case that public policy has an impact on that decision, will we see stresses and strains within the private insurance market and, if that is the case, who better to advise us than the authority?
A strong case was made by the actuaries when they presented their paper on private health insurance. They proposed three options, one of which was to do what the Minister is doing. The other option was a limited compulsory insurance and the third was a universal health insurance system. They pointed out that it would provide more access, generate competition between providers and a more stable framework for financing overall health expenditure, facilitate the integration of primary and secondary care and, by extending the concept of risk equalisation to the whole population in respect of the basic health services, it would de facto bring about a needs based allocation of health care resources.
It could be said that the authority will do no more than the limited area of regulation specified in the Bill but if we set up an authority we should give it a task in terms of the future and the possibility of an insurance based system at a time when a consensus is building that we should have an equal, fair and efficient system. That argument goes back to 1974 when the predecessor of the IMO, the IMA, argued for a compulsory health insurance based system.
I am not necessarily asking the Minister to accept the argument but to allow the authority to examine the future of the market in terms of that and perhaps other contexts but also in terms of what has happened because it has happened relatively quickly. If somebody had taken on the task 25 years ago of assessing what would happen in private health insurance, we would not be in an almost uniquely unfair system of health care at a time when we have tremendous resources and the capability to deliver a good quality service to all.