Matt Shanahan on health insurance changes and public-private care
Matt Shanahan spoke on proposed changes to health insurance funding, outlining reductions to risk equalisation payments, the introduction of high-cost claim credits, and reduced stamp duty feeding a central support fund. He welcomed the high take-up of private health insurance but warned of policy inequities and said he would support an amendment to protect Model 2 hospitals.
Proposed insurance changes
He noted the bill reduces the amount paid to insurers by way of risk equalisation based on age and gender credits, introduces a new system of high-cost claim credits and reduces stamp duty payable into the central support fund. He said the scheme was presented as revenue neutral and that any surpluses or deficits would be rolled over into following years.
Take-up and policy inequities
He welcomed that over 2.3 million people now hold health insurance policies but flagged large discrepancies between lower- and higher-end policies as people age. He highlighted the burden on pensioners paying high premiums and said the measures should address some of those inequities among policies.
Private versus public hospital activity
He argued private hospitals focus on fast, repeatable procedures that generate fee income, while the public system fulfils a social contract covering chronic, complex care funded by the public purse. He cautioned that implementing slaughter care will be difficult because it must combine private-sector efficiencies with a public-good focus.
Workforce and consultant contract pressures
He warned of significant recruitment obstacles, saying many newly qualified doctors will not accept the public consultant contract and may emigrate, and that there is no bursary scheme to bind newly trained doctors to service. He also said long-serving consultants are near the end of their time in the system, meaning substantial reform and retention work is required.
Home-based and outpatient alternatives and amendment support
He supported using Level 2 hospitals for tests and scans funded by private insurers and highlighted schemes such as the VHI hospital-at-home and OPAD therapy, the outpatient antimicrobial therapy, as ways to free hospital beds. He said some pilots are unnecessary and urged decisive implementation, and he confirmed he would support Deputy Nocton's amendment to remove discrimination against Model 2 hospitals.
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I am happy to be here just to contribute to this debate this evening on health insurance and I note from the preamble in the Oireachtas, essentially we are talking about reducing the amount of money paid to insurers by way of risk equalisation based on the credits of age, gender level of colour, also known as age-related health credits. We are introducing a new system of high-cost claim credits and reducing stamp duty payable on all health insurance policies that feeds into the central support fund, so I presume that these have been largely costed and deemed to be beneficial ministers, otherwise I doubt you would be proposing them and you have said here tonight that the scheme is revenue neutral and any surpluses or deficits that occur are rolled over into the following years. You have also taken note of the high level of take-up of insurance, which now stands at over 2.3 million people in the country now have health insurance policies and that is to be applauded, I would say, but I would also point out to you, Minister, that there is a large discrepancy between different policies as well, you know, and as people age in the present way we do health, you tend to gear up your policies as you become older because, essentially, risk equalisation or not, the chances are that some of the policies at the lower end may not cover you for some of the serious health obstacles that you may face as you age. And so, I think it was referred to here already this evening, you have pensioners there, a couple of pensioners paying anywhere between three and a half and maybe even up to 5,000 euro for the likes of a high-level scheme of insurance and that seems very difficult on people who have paid tax audilies generally and maybe what you are proposing tonight and as this bill progresses, this will deal with some of those, I would call them inequities really. But can I just speak about a couple of things that has come up here a number of times in the debate tonight is the issue of private and public hospitals and private and public activity work. And it is very hard to compare what happens in the public hospital sector with the private hospital sector because they generally relate to different streams of activity. If you are in the private sector, you are looking for fast, straightforward, repeatable exercises that you can turn around, that you basically create fee income and that is what private hospital care is largely based on, private fee income. The public system is the social contract that we have where we decide that we look after everybody regardless of their health needs. But that also includes people who have very, very chronic health needs across a range of medical areas. They require lots of care. They require ongoing treatments both in hospital and in community. And that is picked up largely by the public purse. And so when we talk about slaughter care, we are talking about, in effect, trying to get the efficiencies of the private system while having the public good at the heart within slaughter care policy. And it is going to be a very difficult circle to square, to be quite frank with you, because there is a lot of work to be done in trying to generate that. And I know other deputies have spoke here tonight about the need to implement slaughter care. But I would point out to you there are significant obstacles at the moment in the recruitment of qualified healthcare medical people. We are at present in joining and talking about a new consultant hospital's contract. And if you go and speak to new doctors qualifying, they will tell you a lot of them that they are not going to work in the public system for the contract that is being offered to them. They are going to emigrate. So we will have spent the money educating them. We do not have any system in this country or bursary to provide medical related teaching that will contract them to work in the system for one, two or five years like other countries. So we will just educate them and then we will let them fly. And at the other end of the scale you have people who have worked as hospital consultants for 20, 30 years and they may still have time and their contracts to run. But they are not going to stay in the system much longer because quite frankly they have had enough with a lot of it. So we have lots of reform to deliver within that. I will also speak to you about waiting lists, tests and scans and Debbie Nocton has highlighted there tonight how Level 2 hospitals can do a lot of this work. And I agree with that. And certainly they should be funded by the private health insurers. And that is an easy initiative to put in place, Minister, if the will is there. There are also a couple of schemes around the insurance-backed long-term care. And I would point out the VHI hospital at home, which is a system now where if you are a VHI patient and if your needs are chronic, not acute, you may be able to get minded in your home. So essentially VHI will pay for people to come and deal with you at home. And that is a very efficient system of releasing beds in our public hospitals as well as in the private hospitals. Something along those lines is the OPAD therapy, the outpatient antimicrobial therapy. And at the moment, Minister, we have patients coming into hospital taking up a bed for half a day or a day to receive antimicrobial therapy. That can be done quite easily in the home if we have the nurses or qualified doctors to do it. And again, that is something that I know there is a pilot being discussed at the moment, but we do not need to pilot that. This is simple stuff. We just decide we are going to do it and we see what resources that we have to do it. In terms of Deputy Nocton's case and his amendment, I will be supporting that amendment, Minister. I think it is a discrimination of a Model 2 hospital that any health insurer would not be paying for procedures that they pay for in other hospitals. They are the same procedures and I agree with them that they should not be remunerated under the fund until that case has been levied. But as I say, Minister, the idea of staunch care, I would ask the question, you know, is it realistic in the guise that we are talking about now? And one of the things, and you know I have been around healthcare for a long number of years, one of the things that I notice about a lot of policy discussions, they generally do not include those who actually have to deliver the service. We talk about what we are going to do in terms of efficiency, but we do not speak to the nurses. We talk about what we are going to do in terms of high level clinical management. We do not speak to the CNM's and we rarely involve the consultants to be quite frank with you. And I do not take the view, as other deputies might, that somehow the consultants are an outlying class in medicine and that they are all out for money. I know very many consultants who are quite the opposite. They are very much pastoral people and their first inclination is to serve and to mind and to look after their patients. And we have created the consultants contract that they work under and many of them are quite happy to work under the system. But what they do want is a support minister and they want the proper resources and they want adequate resourcing at the junior levels that they need. If they need registrars, if they need house officers, if they need junior doctors, if they need CNM's, if they need secretaries, they need all of that. And why they are getting basically tanked off is because when they go into the system they do not have that. And that is why you are seeing so many people saying that the system is dysfunctional. The system is difficult and when you offer public health care to all, it is going to remain difficult. We have to learn the efficiencies that are in the private sector. We have to see how we can bring them across into the public sector while getting a risk and getting a payment equalisation for all. Karma of God. 1 2 2 2 3 3 4 5 5 5 6 7 5 7 7
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