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Universal Health Insurance

Dáil Éireann Debate, Tuesday - 19 June 2012

Tuesday, 19 June 2012

Questions (1)

Billy Kelleher

Question:

105Deputy Billy Kelleher asked the Minister for Health the estimated total cost of implementing the universal health insurance; the cost of implementing free general practitioner care; the estimated charges being imposed on persons with and without medical insurance for universal health insurance; the way medical card patients will be included in the scheme: if Troika approval will be required for the implementation of the model; and if he will make a statement on the matter. [29551/12]

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Oral answers (7 contributions)

The Government is committed to fundamental reform of health care that will deliver a single tier health system, supported by universal health insurance, where access is based on need, not income. A new insurance fund will subsidise or pay insurance premiums for those who qualify for a subsidy.

As part of the reform programme, the Government is committed to introducing universal GP care within the current term of office. It has given its approval to the preparation of the heads of a Bill to progress the phased introduction of free GP care. It is envisaged that the first phase will provide for the extension of access to GP services without fees to persons with illnesses or disabilities to be prescribed by regulations under the new legislation. A provision of €15 million was made available in the 2012 Estimates for the first phase. Funding for later phases will be addressed during the budgetary process.

In February I established an implementation group on universal health insurance which will assist in developing detailed implementation plans for universal health insurance and driving implementation of various elements of the health reform programme. It will also assist my Department in preparing a White Paper on financing universal health insurance which will outline the estimated costs and financing mechanisms associated with the introduction of universal health insurance. It will be published as early as possible within the Government's term of office.

The reform programme is a major undertaking that requires careful sequencing for a number of years. The implementation group will continue in existence throughout the health reform process and oversee implementation of the reforms and consult widely. The introduction of universal health insurance and universal GP care is a policy matter for the Government, not a matter for the troika. However, in implementing policies the Government must have regard to the targets agreed with the troika and set out in the national plan for recovery.

I thank the Minister for his reply. He has outlined the steps he is taking for the introduction of universal health insurance. It will be some years before we see the type of model on which the system will be based and the cost implications for the State. The perception is that universal health insurance and universal GP care will be free, but they will have to be paid for by someone somewhere along the line. The issue must be discussed early on as it is a fundamental shift in how we fund the health service and make it available. The people have a right to know who will bear the cost.

Will the Deputy, please, ask a question?

Does the Minister agree that a difficulty arises in the meantime in that the private health insurance system is in crisis? Many families are opting out of private health cover altogether. We now have a situation where people are downgrading the insurance package they normally take out. There is increasing evidence that health insurance providers do not provide adequate cover in the sense that they are changing the terms and conditions of policyholders, in particular of older people. Does the Minister agree that VHI has failed to cover the Mahon private hospital in Cork and that it remains closed? In the context of having competition within the health insurance industry there must also be competition among health service providers and that is an indication that the Minister's policies, even at an early stage, are being undermined by VHI because it is not covering a hospital that could provide adequate care for its policyholders.

The Deputy has asked a number of questions. We all understand that nothing is free and that somebody must pay. However, we are discussing making something free at the point of delivery so that no one need be concerned about being able to pay. I hope all sides of the House agree on this point. We do not want a situation in which someone must make a decision between attending a doctor or paying an ESB bill.

Regarding the Deputy's contentions on the health insurance market, 46,000 people have left the insurance market since the end of March 2007 to the end of March of this year. This is a modest decline in private health insurance coverage, 2% of the overall market. Some 2.139 million people, 46.6% of the population, are still covered by private health insurance.

Everyone is in favour of universal primary care, but we do not know its exact cost or who will bear that cost. If the cost is taken from the Minister's current health budget, services elsewhere will be cut. A couple of weeks ago, we were counting the number of incontinence pads available to people in Kilkenny. This is how serious the situation is.

The Minister is the major stakeholder in the VHI on behalf of the Irish people. In the context of universal health insurance, does he agree that it is flying against his policy of covering private hospitals to increase accessibility and make treatments available to its policyholders?

The Deputy has raised a number of issues. I assure him that I, as the VHI's major shareholder, have made it clear that it is not the company's job to determine the market. However, as a court case involving a particular hospital is ongoing, it is not wise for me to comment on the specifics of this issue.

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