Tá súil agam go bhfuil cóipeanna eile ag teacht. B'fhéidir go bhfuil an gluaisteán briste.
In the first place, I would emphasise that it applies only to the self-employed. An insured person, as such, is eligible for these health services, irrespective of what his unmarried sons or daughters may be earning. Thus, you could have the position where a jobbing tradesman, working on his own account in a small way, would be excluded from eligibility because he had, say, two working sons living with him while they themselves, if working under a contract of employment, would be insured and would be eligible. Secondly, while we can all agree that sons and daughters should be willing to help their parents, it must be conceded that there are often circumstances when they would find it hard to do this for understandable reasons— for example, a girl might be saving to get married, or a boy might be attending a night course to get a qualification or degree at a technical institute or university, with the expense which that involves. Looking realistically at these factors, it seemed to me that it would be only equitable to change this rule for assessing the eligibility of a self-employed person, so that the means of the unmarried sons or daughters in the household would no longer be taken into account. Accordingly, subsection (3) of section 1 makes a change in section 15 of the 1953 Act so that, in future, only the person's means and any means his wife may have will be taken into account.
When we turn to the farmers, it is not quite as simple to decide what to do to keep them reasonably in line with the insured. In 1958, when the limits for insured persons and for self-employed were raised from £600 to £800 a year, no change at all was made in the limit for the eligibility for farmers. The reason for this was that what was being done then for the other limits merely represented a rough compensation for the fall in the value of money between 1953 and 1958. A man who had £600 a year in 1953 was, roughly speaking, as well off as one with £800 a year in 1958. Therefore, the object of the change in 1958 was merely to restore the limit for eligibility in real terms to what it was originally in 1953. It was not, therefore, necessary at that time to make any change for the farmers since a £50 valuation farm was taken as being equated to an income of £600 in 1953, and, therefore, a farm of the same valuation would obviously be equated to an income of around £800 in 1958.
This time, however, it is different. The change in the income limit for insured persons and others from £800 to £1,200 a year does more than compensate for the fall in the value of money since 1958. If we were only to make such a compensation, then the limit would merely be increased from £800 to about £1,000 a year. The change to £1,200, therefore, represents an increase in real values of about 20 per cent. In justice, therefore, a similar increase is due for the farming community. Hence it is proposed to raise the valuation limit for farmers from £50 to £60.
Deputies may ask why we should now be making a real change in the criteria for eligibility for these services when this was not done in 1958. The answer is that, between 1953 and 1958, the relevant medical costs—and, in particular, hospital costs—did not change very much. In recent years, however, costs have gone up considerably. For example, the charge in a public ward in a Dublin teaching hospital has increased from 6 guineas to £17. 10.0. a week since 1961. The reasons for these large increases in cost are complex. They reflect increases in remuneration for hospital staff, the provision of better and more complicated equipment in institutions and general improvement in the scope and quality of services, as well as increasing prices.
As a result of these increasing costs, it has become more difficult even for persons who are quite well off to budget to meet the costs of hospital treatment. The Government considered, therefore, that it would be equitable to make some adjustment so that a higher proportion of the population could use the hospital and specialist services and the other relevant services under the Health Acts. Hence, under this Bill, the limit is to be raised to £1,200 a year and the adjustment I referred to is to be made for the farmers. The effect of all these changes will be to increase the proportion of the population entitled to avail themselves of these services from an estimated 85 per cent to something over 90 per cent. I should stress that over 90 per cent of the population are not now getting entirely free medical services. The effect of these changes will be to increase the proportion of the population entitled to avail of these services from an estimated 85 per cent to something over 90 per cent.
I would like to inform the House that I have had discussions with representatives of the Irish Medical Association and of the Medical Union on the proposals in this Bill. The Association and the Union were understandably perturbed lest the changes should adversely affect some of their members, particularly those who, as well as participating in the health authority services, have private practice in the higher income group. I pointed out that at present it is not possible to know how exactly this change might affect their members, bearing in mind that many in the group now being brought into eligibility might prefer to continue to go to hospital as private patients. This should apply particularly to those covered by voluntary health insurance. I told the deputation that if, when the picture becomes clearer, it appears that they have been adversely affected, to a substantial extent, by the change, I will not be unsympathetic towards arranging some compensation by way of adjustment of their remuneration from public funds. Whether this will be necessary, and the extent to which it will be necessary, can only become known after the changes proposed in the Bill have been in operation for some time.
In a communication received within the last few days, the Irish Medical Association has told me that it was opposed to a comprehensive medical service on the principle that the profession would be expected to give free service to individuals who are capable of making provision for themselves without significant hardship and that this opposition applies equally to the extension as now proposed. It is as well that this statement of the policy of the Association should be on the records of the House. I agree with the views of the Association in regard to the giving of free service to those able to provide it for themselves without hardship but I disagree with them that this principle is violated by the changing of the income limits proposed in the present Bill.
This Bill will not affect the fundamental pattern of the health services. It affects only the limit for eligibility for hospital services, including mental hospital services, the specialist services and the maternity and infant care service. However, in the light of recent references in the House to a free for all comprehensive service, I think that I should emphasise that when this Bill becomes law about 90 per cent of the population will be entitled to receive, from health authorities, full hospital care in public wards and complete out-patient specialist services. All medical fees, drugs, medicines, nursing, radiology, pathology and other services for such persons in public wards are paid for by the health authority. The only payment which may be required of such a person would be by way of the charges which the health authorities may make in certain cases.
These charges may be made only on persons in the middle income group and in no case can the charge for intern treatment be higher than 10/-a day. I would emphasise that this is a maximum charge which is made only in a small proportion of all the cases where charges are made. The charge for out-patient services also applies only to the middle income group and is at the rate of 7/6 for X-rays and 2/6 for other attendances. As many Deputies will know, from their own experiences, by far the greatest financial worry that can arise in medical care is in the arrangement of hospital treatment. As I have mentioned earlier, the cost of this treatment had increased very much in recent years and it is obviously necessary that the State should organise this comprehensive service for the very high proportion of our population which is entitled to it.
Because of the fact that the income limit for insured persons in non-manual employment has increased already and that the increase for self-employed persons proposed in the Bill has not yet come into effect, there may be some confusion on the exact definition of the groups entitled to the hospital services at present. I am afraid that, until this Bill comes into operation, some such confusion seems inevitable but, when effect is given to the Bill, I propose to arrange that local health authorities will revise their information leaflets on these services so as to have available, to members of the public, up-to-date information on eligibility, on where the services are available locally and on how to go about using them.
This Bill will not, of course, affect in any way the present law on determining eligibility for what we describe as the lower income group health services. The most important of these is, of course, the general medical services provided through district medical officers. I have mentioned that this service, and the determination of the group eligible for it will be particularly dealt with in the proposed White Paper. I mention it now merely to emphasise that, for the present, there will be no change in the existing law which states that eligibility for that service is determinable by the local health authority, in each case.
I recommend this Bill to the House for a Second Reading. I hope Deputies will agree that it makes opportune and necessary adjustments in the standards of eligibility for the services with which it is concerned. I apologise to Deputies on the opposite side of the House that I did not have copies of my speech. I hope to have them shortly.
