A quarrel has arisen between the Voluntary Health Insurance Board and a group of health providers. That is not a new situation. Nor is the consequence. As in the case of the dispute with consultants, it is once again the ordinary man or woman in the street the patient in the bed who must suffer the cost and inconvenience, this time of the failure of the VHI to come to terms with the Independent Hospitals' Association of Ireland.
There is another parallel with the consultants dispute. Health in this State is not simply a question of an industry supplying the needs of the ill. Powerful interests have developed which defend their own corners, and their members' financial position, by using arcane arguments that have an ostensibly altruistic purpose. The IHAI contends that the VHI acts anti competitively and to the detriment of its subscribers by restricting their freedom of choice; the VHI argues that it is the IHAI that violates the rules of normal competition by increasing hospital charges across the board at the same rate. Both sides have invoked the law, and if they cannot agree no doubt a decision will be forthcoming in due course after costly proceedings in which the interests of the consumer, who ultimately pays, will not be the first priority.
This is no way to provide a health service. The opening principle must be that when one is well one pays, and when one is ill one doesn't. That is the reason why people pay insurance, and also the only reason why the VHI exists. Yet there are thousands of subscribers who have paid their dues, in some cases for many years, to find that the benefits they expected to be available when they needed them can no longer be claimed. There is no other organisation in the State which operates, as the VHI does, on the basis of a unilaterally shrinking contract while its charges, at the same time, rise steeply and implacably. Its clumsy handling of customer rights in regard to the IHAI is a further encroachment on the freedom from worry that patients are entitled to expect.
As Ms Maire Geoghegan Quinn, the Fianna Fail spokeswoman on health, pointed out in the Dail last November, premium rates had risen by 18 per cent in the previous year and a half and another rise of 3 per cent had been announced. As part of the remedy, she suggested that a VHI users' council should be set up so that the voice of the consumer could be injected into the debate. The arguments are dominated at present by the professional interests, on the one hand, and the VHI on the other a VHI which is unable, in current conditions, to exercise any control over the market. Who, in this situation, is responsible for overseeing the development of a system of provision which is adjusted to the different needs of patients? Large savings can be made in some activities without reducing standards, as some health authorities in Britain are proving by judicious reorganisation. The system we have now is market oriented without being competitive, and it is far from being cost conscious enough.
It remains to be seen whether the Voluntary Health Insurance Bill, which has still to be put into effect, will alter the situation for the better. One of the expectations is that it will turn the VHI into a "price maker" as opposed to a "price taker", but that concept has been specifically opposed by providers. The VHI is also expected to be strengthened to compete on a more open market for health insurance. Most of all, its subscribers will want to be assured that they will get reasonably comprehensive coverage which is not subject to arbitrary and unpredictable restrictions. The current dispute with the IHAI is riddled with obscurity, and it may be necessary for the Government to intervene to throw light on the issues involved.