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Health Insurance Prices

Dáil Éireann Debate, Tuesday - 1 April 2014

Tuesday, 1 April 2014

Ceisteanna (102)

Bernard Durkan

Ceist:

102. Deputy Bernard J. Durkan asked the Minister for Health the extent to which increases in private health insurance continue to be monitored with a view to identifying the extent to which costs increases annually over the past five years have been identified as being attributable to any particular issue, cause, action or procedure; if any action is contemplated which might be likely to have a stabilising effect on such insurance costs in the future; and if he will make a statement on the matter. [14826/14]

Amharc ar fhreagra

Freagraí ó Béal (17 píosaí cainte)

My question relates to ongoing private health insurance premium increases which are leaving the public somewhat concerned about both the rates of increase and their number. Notwithstanding community rating, which we all support, is it the case that increases in excess of the amounts required are being imposed?

I thank the Deputy for raising this issue which is of critical importance. I have consistently emphasised the need for much greater cost control in the private health insurance industry in order that premiums are affordable for as many people as possible. My Department and the Health Insurance Authority, HIA, monitor the factors that contribute to costs on an ongoing basis.

The health insurance market is challenged by factors such as an ageing population, a reduction in numbers holding private health insurance and constant pressures on claims costs. However, I am determined to address these issues and to promote a sustainable private health insurance market as we move to universal health insurance.

I appointed an independent chair to work with health insurers, the HIA and my Department to identify effective strategies for costs management. Mr. Pat McLoughlin's first report, published at the end of December, made a number of important recommendations now being pursued by insurers, the HSE and my Department. These recommendations include measures to control costs, greatly improve clinical audit, streamline claims processing, and address fraud, waste and abuse in the industry.

As recommended by Mr. McLoughlin, I am also looking favourably at the scope for introducing lifetime community rating and other measures to encourage younger people to buy health insurance. Work on the second phase of Mr. McLoughlin's report, which will deal further with the factors driving costs in health insurance, is progressing well and will be completed as soon as possible.

The Government remains committed to keeping down the cost of private health insurance in the transition to universal health insurance.

I thank the Minister for his reply and his concern in this regard. Has it emerged from an examination of the figures available to date if there is a particular reason for the increases, other than the ageing population and the drop-out of many young families from private health insurance? To what extent are the costs of services being put forward as an ongoing reason for increases in such services?

Is regard being taken of the fact that the aged population also contributed when they were young? To what extent are all other insuring bodies in this country taking a fair share of the burden?

I do not think any specific reason has been identified to date but the matter continues to be examined. I am concerned that in the past there has been a history of passing on increases to the customer. There was an acceptance, or even a resignation, that medical inflation runs at 9% yet in some years we have seen health insurance costs for consumers increase by up to 25%. That is not acceptable to me and it is why I am asking for much more robust auditing, particularly from the semi-State insurer, the VHI. On behalf of the people, I am the sole shareholder in the VHI, so I want to see a clinical audit introduced there in a far more aggressive and robust manner than has been the case to date. Anecdotally, we hear about many tests being done, the value of which could easily be questioned by a competent fellow professional.

Why are we still paying the same rate for procedures that used to take two hours but which now take 20 minutes using modern technology? A whole range of services are currently being provided in this way whose prices should be reduced dramatically.

We must also examine the appropriate skill-mix in the private health sector. Procedures are being carried out by specialists in hospitals, which attract a specialist's fee and the side-room fee, which could be carried out in primary care. Some of these procedures could be carried out by advanced nurse practitioners. All these areas need to be addressed and will be as a consequence of Mr. McLoughlin's report.

I thank the Minister for his reply. We await the report with some interest. Despite the number of insurance companies now in the market-place, we must recognise the fact that when there was only a single operator in this country there was not the same emphasis on insurance premium increases. We were told at that time that more competition would lead to lower insurance premiums but to what extent has extra competition contributed to keeping insurance premiums down?

The Deputy has raised a valid question. The whole point of having a number of insurers is to create competition in the market-place. So far, however, this has not led to the sort of changes we would like to see. The main insurer in the country is the semi-State VHI which, although it is only responsible for 57% of the market, is responsible for 80% of the payout. The VHI now has a wonderful opportunity to attack this cost base.

The number of insurers in the market is healthy. However, the Health Insurance Authority will be empowered, through legislation, to play a much greater role in regulating the market. In particular, we currently have an outrageous situation whereby there are over 256 different policies. My view is very clear: the only reason there are that many policies is to confuse the customer. There should not be more than ten different policies to allow people to compare like with like and make an informed decision. I will be encouraging the HIA to examine that.

Would the Minister agree that Mr. Pat McLoughlin's review should also take into account Government policies on premium increases, the cap on tax relief and full cost recouping for private patients in public beds? These are key issues that have inflated private health insurance costs.

In the context of asking the HIA to police the health insurance market, the Minister has many times dismissed the authority's recommendations and overruled them. He brought forward policies that the HIA said should not be introduced.

On the matter of lifetime community rating, it has been obvious for some time that the market is in terminal decline. Young people are not taking it up. That is a direct result not only of the difficulties in the labour market but of Government policy implemented in the House.

The Deputy pointed his finger down, which is where he left the economy.

Gold-plated, the suggestion was.

The Minister is giving the usual old answer - the usual old mantra.

The Fianna Fáil way is to ask a question and listen to its own answer. Good man, Barry.

It is Deputy Cowen.

Do we want to have a conversation or just the Deputy asking questions and answering them himself?

We want action. Conversations we have had a long time ago.

The Minister to reply.

As I have said in the Chamber before, there is a figure of 250,000. It is also the case that 250,000 people lost their jobs, 250,000 extra medical cards were issued and 250,000 people gave up their health insurance. I did not say they were all one and the same people, but there must have been some relationship.

I accept that the cost of private health insurance has increased. I have striven to keep it down and encouraged the VHI in that regard. As the main insurer, the VHI's increase this year has only been 3% despite the removal of some of the tax subsidy. The cost of the subsidy to the taxpayer two years ago was €400 million. It was €450 million last year and would have been €500 million this year. How much further were we to allow it to go? Pressure had to be brought to bear on that. The private inpatient charge does not reflect anything like the true cost of a bed. The private insurer will still make a profit.

I have no doubt that with improved regulation from a Health Insurance Authority with more teeth to act, allied with the national pricing office, which is now up and running on an administrative basis, we will get much better value for money for people who are insured privately.

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