Dáil Éireann díospóireacht -
Friday, 24 Feb 1928

Vol. 22 No. 4

VOTE 43—NATIONAL HEALTH INSURANCE COMMISSION.

Mr. BLYTHE

I move:—

Go ndeontar suim bhreise ná raghaidh thar £7,686 chun íoctha an Mhuirir a thiocfidh chun bheith iníoctha i rith na bliana dar críoch an 31adh lá de Mhárta, 1928, chun Tuarastail agus Costaisí an Choimisiúin Arachais agus chun Ilsíntiúisí agus Ildeontaisí mar gheall ar chostas Sochar agus Costaisí Riaracháin fé sna hAchtanna um Arachas Sláinte Náisiúnta, 1911 go 1925 (maraon le Deontaisí áirithe i gCabhair).

That a supplementary sum not exceeding £7,686 be granted to defray the Charge which will come in course of payment during the year ending on the 31st day of March, 1928, for the Salaries and Expenses of the Insurance Commission and for sundry Contributions and Grants in respect of the cost of Benefits and Expenses of Administration under the National Health Insurance Acts, 1911 to 1925 (including certain Grants-in-Aid).

General MULCAHY

The items that are covered by this Estimate are an increase on the amount estimated as being the cost of actuarial work for the year 1926-1927 in respect of the valuation of the insurance societies which was due that year. There is a slight increase in the actuarial Estimate under F 2. The reason for that Supplementary Estimate is that the figure for expenditure for the first six months of the current year is such as to indicate that the expenditure will be greater than was anticipated under this sub-head. In connection with the Appropriations-in-Aid, the work is done by the National Health Insurance Commissioners in the Free State, who give medical benefits to discharged British soldiers here. For this particular work the British Government pay, and it is estimated that we will receive during the current year £98 more than was originally estimated for.

Mr. LITTLE

I think this Vote should be opposed. Those people who are registered, who come under the National Health Insurance Act, and who are ill, perhaps for a short period, have to wait a very long time before they can get the money, and that at the very time they need the money most. They are out of employment; they are suffering from sickness, and the societies make delay in paying them. In that way the administration of the Act is very unsatisfactory. Individuals have no remedy in that matter. I, therefore, think that this opportunity should be used to point out the defects as a preliminary to seeing if some other system could not be adopted by which people who suffer——

AN LEAS-CHEANN COMHAIRLE

I cannot allow the Deputy to discuss the National Health Insurance Act under this Vote.

Mr. LITTLE

Why not?

AN LEAS-CHEANN COMHAIRLE

There is the National Health Insurance Act.

Mr. LITTLE

I am discussing the administration of that Act on the grounds that it is extravagant, and that this should not be. I am arguing that this extra would not be necessary at all——

The PRESIDENT

Instead of delaying the money, the Deputy wants to give nothing——

Mr. LITTLE

No, I know more about the Act than that. At present I mention this because I think it should lead to serious consideration of the whole administration of the Insurance Act. I have known many people who are able to point out the defects in the way in which people suffer. I know cases where people have been contributing for seven or eight years, and because of some technical thing happening they were deprived of the benefits they should have got when they did get sick or were injured. On these grounds, I think that this Supplementary Estimate should be opposed.

General MULCAHY

If the Deputy's point is that further legislation requires to be introduced in order to facilitate persons insured under the insurance companies and societies to a greater extent than now, I take it that that matter is not a matter for discussion on the Estimates. The alternative is that the insurance companies and societies are delaying claims, and that they ought, as the law is at present, pay up earlier than they are paying. It seems to me that that is a matter for taking up with the insurance societies or in some other form. To oppose this Estimate would simply be to reduce State funds that we are making available here for the insurance societies in order to enable them to make the payments that they are statutorily required to make.

Mr. LITTLE

There is a method of exercising discipline over them.

Mr. O'KELLY

One point that I would like to make is in reference to the Vote under the sub-head AA. I would like to know why it would not be possible to employ an Irish actuary to do that same work. I imagine that if it were possible—and I am sure it ought to be—that an Irish actuary would be able to estimate the cost of this work better than to have to go at the end of the year and to ask to have the Estimate increased by 25 per cent. The Minister said it had to be increased by a small sum. An increase of 25 per cent. on a small sum is a considerable amount, and an actuary, who ought to be something of a mathematician, ought to have some experience of his work, and ought to be able to go closer into his estimate than that at the end of the year he should have to alter it to such a large extent. I think there is quite a good deal in the complaints just referred to by Deputy Little. I do not know whether this is the right time to go into them or not. But one does hear numerous complaints, of the administration, for instance. Whether it is the approved societies that are responsible, or the administration at headquarters, I am not at the moment prepared to say. But one hears very frequent complaints, at any rate, and probably when this Estimate is under consideration again these complaints will be aired. I do not know whether it would be right to go into some of them that I have in mind or not. I would like to call the Minister's attention to that statement there in AA, and to ask if it is possible to have an Irish actuary employed, and if not, why would they not get an efficient British actuary, if a British actuary is necessary in the case.

Dr. WARD

The only way we have to mark our disapproval of the manner in which sickness insurance benefits are administered under the National Health Insurance Commissioners is when this Vote is being discussed. It appears to me that in a big percentage of cases the money that goes in procuring National Health Insurance stamps and the stamps in insurance cards is taken under false pretences. I do not say that that is entirely the fault of the Local Government Department, or the fault of the Minister responsible, but the actual practical situation is that when people go to look for sickness insurance benefits, and when they are certified by the certifiers, they find it practically impossible to get benefits extracted out of the societies. People who have been contributing for long periods, some of them for a period of several years, and getting their cards stamped regularly, naturally expect when they become ill, and when they get a certificate from the doctor, that they should be entitled without undue delay to draw insurance benefits. I have been certifying for a considerable number of years for a number of societies—roughly, seven or eight societies— and my experience is that it is rare that any benefits are paid for the first four or five weeks of illness.

That is a very serious matter for the unfortunate people who have no other source of income at the time they are ill unless the benefits to be derived from the National Health Insurance. It has very serious effects on those people. Take, for instance, the mental anxiety of a father who has no source of income and no means of providing the extra nourishment that a person acutely ill would require. The mental anxiety, apart from the physical disability in not being able to diet himself properly, is a very serious consideration.

A big percentage of the insurance certificates are issued for acute illnesses, illnesses that last over a period of one, two or three weeks. It is found in actual practice that people seriously ill for a period of only one or two weeks will not seek certificates at all because of the difficulty experienced in getting benefit from the society. These people rush back to work before they are physically fit to work and the result very often is that their health is permanently impaired and they become chronic invalids; they become a perpetual drain on the State or on the insurance societies with which they are insured.

I have in mind at the moment a particular case, a man to whom I have been issuing certificates for a period of months. The last payment he got was on 1st January this year. He has had no notification from the society that his benefits have been reduced or cut off. He has written to the society and has not even got a reply. I think the Minister, in view of the large amount of public money which is being allocated for the purpose of providing benefits for the people who are ill, should take steps to see that the benefits are made available at the time they are most required.

General MULCAHY

With regard to the matter of the actuary, I do not know whether there is an actuary in the country capable of doing this work. I think the House will remember when the Minister for Finance wanted to get actuarial work done in connection with the proposal to give pensions to secondary teachers he had to go to Britain for a person capable of doing the work. In connection with the National Health Insurance finances the apportionment of the finances as between Northern Ireland and the Saorstát as in February, 1922, was actually only completed in 1926. The five yearly valuations of the insurance societies' funds that should have taken place in 1923 did not actually take place until 1926, I think, so that even if there was an Irish actuary here capable of doing this particular work there probably would be, and actually were, circumstances in the past that made it very desirable that the person who had been dealing as an actuary with the National Health Insurance scheme generally under the old régime should be the person who should do the recent work. If it is a fact that there are persons competent to do the work in the Saorstát I would be glad, and I am sure the National Health Insurance Commissioners would be quite glad to examine the situation and see whether the work could not be done by a Saorstát citizen.

With regard to the statement made by Deputy Ward, any complaint of non-payment or delay in payment of benefits under the National Health Insurance that is made to the Commissioners will be fully investigated.

Whether it is a matter of fact or simply an atmosphere that grows up around a particular institution, I cannot say, but you do hear a great volume of complaint here and there among people with regard to delay in the payment of National Health Insurance benefits. I doubt if the amount of fact is really as great as the amount of complaint, but if the facts are there to be complained about, then there is full machinery in the hands of the National Health Insurance Commissioners to take those facts, whether individual facts or a volume of facts, and go into the whole matter and see that the societies do equitably discharge their duties.

Vote put, and agreed to.