Written Answers Nos. 185-190
185. Deputy Bernard J. Durkan asked the Minister for Health if particular steps have been taken to ensure that those with specific or severe health needs or conditions are allowed to maintain their medical cards notwithstanding the budgetary situation he inherited; and if he will make a statement on the matter. [48543/13]
Amharc ar fhreagra190. Deputy Bernard J. Durkan asked the Minister for Health the steps he has taken to ensure that medical cards are not arbitrarily withdrawn from persons with severe terminal illness; and if he will make a statement on the matter. [48548/13]
Amharc ar fhreagraI propose to take Questions Nos. 185 and 190 together.
Under Section 45 of the Health Act 1970, as amended, persons who are unable, without due hardship, to arrange a general practitioner service for themselves or their family qualify for a medical card. There is no automatic entitlement to a medical card for persons with a specific illness or disability.
Under this legislation, the determination of eligibility for a medical card is the responsibility of the Health Service Executive. Section 45 requires the HSE to have regard to a person's, and their spouse or partner's overall financial situation in view of their reasonable expenditure. The HSE gives effect to this legislation and Government policy through its Medical Card National Assessment Guidelines.
Where a person's income is in excess of the income thresholds set out in the National Assessment Guidelines, the HSE uses its discretion to grant a medical card to a person who is unable, due to undue hardship, to arrange a GP service. In doing so, the HSE is obliged to have regard to the financial situation and expenditure of the individual and his or her dependents.
Since the beginning of 2011, the Government has taken measures and provided funding to ensure that an additional quarter of a million people have a medical card. Over 40% of the population now hold a medical card, which is the highest proportion since records began.
The HSE has an effective system in place for the provision of emergency medical cards for patients who are terminally ill in palliative care, or who are seriously ill and in urgent need of medical care that they cannot afford. They are issued within twenty-four hours of receipt of the required patient details and the letter of confirmation of the condition from a doctor or a medical consultant. With the exception of terminally ill patients in palliative care, the HSE issues all emergency cards on the basis that the patient is eligible for a medical card on the basis of means or undue hardship, and that the applicant will follow up with a full application within a number of weeks of receiving the emergency card. As a result, emergency medical cards are issued to a named individual, with a limited eligibility period of six months.
For persons with a terminal illness in palliative care, no means test applies. Once the terminal illness is verified, patients are given an emergency medical card for six months. Given the nature and urgency of the issue, the HSE has appropriate escalation routes to ensure that the person gets the card as quickly as possible.
Renewal assessment forms automatically issue to the holders of all medical card or GP visit cards, three months prior to the expiry date of the card.
186. Deputy Bernard J. Durkan asked the Minister for Health if any particular study has been done into the increases in private health insurance over the past number of years in view of the fact that increased competition in the area was supposed to benefit the consumer; and if he will make a statement on the matter. [48544/13]
Amharc ar fhreagraThe Health Insurance Authority, the independent statutory regulator of the private health insurance market in Ireland, provides advice to my Department on an ongoing basis. The data available on the private health insurance market in recent years shows a number of factors which are affecting private health insurance costs. The reduction in the numbers holding private health insurance, the age profile of those holding private health insurance, increases in claims costs, increases in premiums, and the overall state of the economy are all having an impact on the private health insurance market and its sustainability.
I am determined to address rising costs in the private health insurance sector in the interests of consumers. I want insurers to address their base costs, and have made it clear to insurers that I believe significant savings can be made, ultimately reducing the impact of rising health costs on health insurance premiums for the consumer. Last year I established the Consultative Forum on Health Insurance, comprising representatives from the private health insurance companies, my Department, and the Health Insurance Authority, to generate ideas to address health insurance costs. I appointed an independent Chairperson Mr. Pat McLoughlin who is working with my Department and the insurers under the auspices of the Forum on a review process to give effect to real cost reductions in the private health insurance market and I expect to receive his initial report shortly.
While competition is evident in the Irish private health insurance market, insurers have concentrated on competing for younger lives. Competition in a community rated health insurance system needs to be supported by risk equalisation, a mechanism to distribute fairly some of the differences that arise in insurers' costs due to the differing health status of all their customers. There has been a history of challenges to risk equalisation in Ireland, with the original risk equalisation scheme struck down in 2008. A temporary scheme was introduced in 2009, which I greatly improved in 2012 and I also put in place a permanent scheme of risk equalisation for the first time in 2013. There is a need to continue developing risk equalisation in order to protect the health insurance market and to ensure competition is on the basis of service and quality, not risk profile and I encourage insurers to compete actively to insure all lives.
187. Deputy Bernard J. Durkan asked the Minister for Health if, in the context of private health insurance, efforts have been made to encourage all insurers to take on a cross-section of the age cohort thereby preventing advantageous trading by any insurer; and if he will make a statement on the matter. [48545/13]
Amharc ar fhreagraI am conscious of the need to ensure that there is a fair and balanced private health insurance market in Ireland. The Health Insurance Acts 1994 to 2012 provide the statutory basis for the regulation of the health insurance market in the interest of the common good. At the centre of the common good in a community-rated health insurance market is inter-generational solidarity between all insured persons. Under community rating, everybody is charged the same premium for a particular health insurance plan, irrespective of age, gender and the current or likely future state of their health. The objective has always been that the price of a policy should reflect the risks and costs of the entire pool of insured persons in the community, rather than the risks and costs on a person by person basis and indeed on an insurer by insurer by basis.
The pricing of risk across the community of insured persons requires robust mechanisms to share costs when there are a number of insurance companies in the market. If a mechanism to share risk and attendant costs is not present, an insurer with a less profitable risk profile can quickly find themselves in a perilous position financially. The standard transfer mechanism is known as risk equalisation and it is a key element of health insurance, not just in Ireland but internationally. Risk equalisation is a process that aims to equitably neutralise differences in insurers’ claim costs that arise due to variations in the health status of their members. The aim of risk equalisation is to look at the market as a whole, and to distribute fairly the differences that arise in insurers’ costs due to the differing health status of all of their customers. Risk equalisation aims to make health insurance more affordable for older people by supporting community-rated premiums. In general, younger people pay more and older people pay less than what would normally apply in a risk-rated system.
I am committed to progressively increasing the extent to which risk equalisation compensates for the costs of insuring older customers. A permanent Risk Equalisation Scheme (RES) was introduced with effect from 1 January, 2013. Prior to the introduction of the permanent RES, an Interim Scheme of Age-Related Tax Credits and Community Rating Levy had been in operation from 2009 to 2012. Yesterday I received Government approval to the immediate publication of the Health Insurance (Amendment) Bill 2013, which sets out revised risk equalisation credits and the corresponding stamp duties that will apply under the Risk Equalisation Scheme from 1 March 2014. Different risk equalisation credits will apply to 'advanced' and 'non-advanced' health insurance policies. There will be no change to the stamp duty payable on lower cost 'non-advanced' health insurance, which will help to ensure that the option of lower cost health insurance remains available. The stamp duty for health insurance products providing 'advanced' cover will increase from €350 to €399 per adult and from €120 to €135 per child. This will help direct support, in the form of higher risk equalisation credits, where it is needed most and will subsidise health insurance for the most vulnerable patients. Under the Health Insurance Acts, I set the rates for risk equalisation credits and the Minister for Finance sets the rate of stamp duty require to fund those credits.
These measures will ensure that we continue to protect community rated health insurance, which is a vital part of our health system, now and in the future as we move to Universal Health Insurance.
188. Deputy Bernard J. Durkan asked the Minister for Health the number of instances reported whereby patients seeking treatment for cancer have been put on waiting lists; and if he will make a statement on the matter. [48546/13]
Amharc ar fhreagraThe quality and safety of our health services, including cancer services, has been a focus over the past number of years and this will continue in 2014 in the context of the HSE Service Plan for 2014. I wrote to the HSE on Thursday 31 October to confirm that the Executive has until 15 November to submit its Service Plan. In that letter, I also conveyed to the Executive that my overriding priority is patient safety, with the next priority being to treat patients in as timely a fashion as possible. A key priority for 2014 will be to further support the eight designated cancer centres, within available resources, to maintain continued improvements in diagnosis, surgery and multi-disciplinary care.
Clearly, the diagnosis and treatment of patients with cancer is a high priority for my Department and the HSE. I welcome the huge improvements that have been made in recent years, led by the HSE National Cancer Control Programme. It is very encouraging to note that five year relative survival for all cancers is rising and is now 56.4% for people diagnosed between 2003-2007, as compared with 49.6% for people diagnosed in 1998-2002. The HSE has established symptomatic breast clinics and rapid access, lung and prostate clinics in each of the eight cancer centres. Performance of these clinics is monitored through the collection of key performance indicators. The HSE has advised that in Q3 2013, access targets for both urgent and routine referrals to breast cancer clinics are being exceeded in the designated cancer centres in aggregate (95%). In relation to access to lung cancer clinics, 94.9% of patients in Q3 2013 in aggregate were offered an appointment within 10 working days, just under the target of 95%. While further progress is required in relation to access targets for prostate cancer clinics in Q3, the percentage of patients being offered an appointment within the target time is 50.2%, up from 47% last year. All referrals to these centres are triaged and urgent cases are prioritised and appointments offered to all appropriate patients in the first instance.
With regard to paediatric cancer care, Our Lady's Children's Hospital Crumlin is the national tertiary paediatric and adolescent referral centre for all cancer services. I am advised that children are treated according to international protocols and standards of care, that all care is clinically prioritised by consultants and that there are no extraordinary delays for children accessing cancer services.
In relation to the Deputy's query regarding the number of instances reported whereby patients seeking treatment for cancer have been put on waiting lists, as this is a service matter, I have asked the HSE to reply to you directly on this.
