Thursday, 29 November 1928
Dáil Éireann Debate
General MULCAHY: I beg to move the Second Stage of this Bill. The Bill is identical with the Bill passed in 1927 and 1926. Under subhead (h) of the National Health Insurance Estimate, we make a contribution of £36,750 for medical certification and for second medical opinions. This Bill makes the same provision as was made last year and the year before by which, in addition to that amount, £8,414 is actuarily available from the Societies for the administration of the Act, which will be added to that amount for the purpose of paying medical certification and second medical opinions. It was necessary for the last couple of years to introduce a Bill like this for the reason that legislation arising out of the National Health Insurance Report has not been introduced. The £8,414 that is available arises from the fact that the National Health Insurance scheme provided 6d. per head for the administration of the Insurance Committees, of which only 4d. is required. It leaves 2d. per head per annum available, and there is a difference of 3d. available per head per annum out of the general National Health Insurance contributions, because of the fact that the contributions that are made are only adjustable to the nearest halfpenny, so that the money that is actuarially available in the administration of the Act is taken for the purpose of reducing the State expenditure on medical certification.
General MULCAHY: As far as I am concerned, the Bill is practically drafted. It is still in the hands of the draftsman. I did think it would be possible to introduce it during the current session, but the pressure of  other work in the draftsman's office and in this House prevented that. I have every reason to believe that the legislation will be introduced in the spring.
Mr. KENNEDY: I do not know am I to the point in raising a matter with reference to the National Health Insurance Medical Board. The particular grievance that arises in my district is that men have been brought long distances from Cavan to the Medical Board in Mullingar, that is a distance of seven or eight miles. Secondly, men in the rural districts about eight miles from a railway station have been sent railway vouchers to travel to these Medical Boards, and in some cases the distance was ten statute miles by road. It is impossible for a labouring man to get a car to go from an out-of-the-way place to a railway station to connect him with Mullingar to avail of these vouchers. I made representations on the matter to certain societies, but they did not heed me. I would like if the Minister would look into that with a view to seeing that car fare would be provided in addition to railway vouchers in rural areas where there is no railway, that a Medical Board should be held at convenient centres, and that where local authorities object to the use of the dispensaries for some invalid reason, or some reason that has no sense behind it, the Local Government Department should insist that the dispensaries are made available for these Boards, and not bring people big distances, such as from Cavan to Westmeath.
Mr. P. HOGAN (Clare): I understood the Minister to say that a certain amount would be taken out of the administration funds to provide the money necessary for medical certification. I would like the Minister to tell us that it will not be the case that the better the society is managed the more it will have to pay for medical certification.
Dr. O'DOWD: Would the Minister give us any assurance that something in the nature of permanency will be done about this. Year after year the Minister introduces a Bill to legalise the amount paid for certification. It is most unsatisfactory to have that amount fluctuating year after year. I think it would be an easy matter to introduce something in the nature of a permanent arrangement. There is another point. Recently a circular was sent out to the medical certifiers in the Saorstát asking them to agree to a change in the area of certification from the dispensary to the county area. It was held by the National Health Insurance Commissioners that it was difficult to get a dispensary area defined. I suggest it is quite an easy thing to get an insured person's membership card instead of the dispensary area in which he resides. I suggest nothing is simpler. Although I was one of the certifiers who signed the circular, I did not examine it sufficiently, and I think the Minister should adhere to the old system of dispensary instead of county certification.
General MULCAHY: I take it that the matter referred to by Deputy Kennedy is the distance persons have to travel when going before the medical referees when second medical opinions have been asked. The amount for a second medical opinion is small, and the number of people engaged on that is very small. I take it persons who are called before the Board have to travel some distance instead of having the referees going to every place where persons requiring a second medical opinion reside. No difficulties in that connection have been brought before me, and, if they are brought before me, I will go into the matter. There is no question of dipping into the surplus of any particular society, except to the extent that actuarially there is a surplus in the whole National Health Insurance scheme of 3d. per head because of the fact the moneys that are paid  into the National Health Insurance Fund as contributions in respect of each particular individual are brought down to the nearest halfpenny. Nothing has been taken from the societies to which they are strictly entitled. That refers to the threepence. In the case of the twopence, certain moneys are made available for the administration expenses of the county committee. Sixpence is made available, out of which fourpence is spent and the other twopence is taken. It is not taken from the society in any way.
General MULCAHY: The only thing that can happen to any person in a society, whether it is well managed or not, is that the threepence goes into this particular certification, and in respect of the whole country, what the National Health Insurance Committee get is £8,414, which gives £36,000 odd provided by the State for medical certification. There is no injustice being done to anyone. It is following out what has been done since 1924. During 1924 and 1925 5d. extra was taken out. It was considered afterwards unfair to the societies to take that 5d., and that was dropped in 1926 and 1927, and it is being dropped now. What is being done now is what has been systematically done for the last five years. With regard to making the matter permanent in State legislation dealing with the recommendations in the National Health Insurance Report, as I have said, I feel certain that the matter will be before the House in the spring. This matter will be made permanent in any kind of legislation that will be introduced at that particular time.
As regards the circular that Deputy O'Dowd spoke about, the matter of distributing the medical certification  funds to the doctors to carry out certification, that matter has been given for a long time past a considerable amount of consideration, both by the National Health Insurance Commissioners and the Department of Finance. The arrangement that exists is, both from the point of view of the Commissioners and of the Department of Finance, an unsatisfactory one, and from the point of view of the State it is particularly costly. However, I am in consultation with the representatives of the doctors in connection with this matter, and I hope that a satisfactory arrangement may be come to. If necessary, a further opportunity of discussing the matter can be taken. Neither the Department of Finance nor the National Health Insurance Commissioners and the Department of Local Government can stand for an arrangement that is unnecessarily costly in the first place, and is inequitable as between persons carrying out the same class of work.
General MULCAHY: It is not so easy as the Deputy suggests to keep track of every single person who is insured. We had plenty of opportunities of seeing that in the discussions that took place here in connection with the repealing of the Prolongation of Insurance Act. It is not easy for the society to keep track of all their members, and it certainly is not possible, I might say, for the National Health Insurance Commissioners to keep track of the location of every particular person who is in National Health Insurance at the present moment. However, the matter is being fully discussed as between the Department of Finance, the Insurance Commissioners and the doctors. That is all I can say at the moment.
Dr. O'DOWD: I suggest that instead of making the county the area, it is quite an easy thing to put the insured person in the dispensary district instead of the county. I do not see why it would not be as easy for the Insurtie  ance Commissioners to get that done one way as the other.
Mr. MOORE: I wish to raise a matter that I am not sure is quite in order, but I think the Minister should give attention to it. It is that insured people should have an opportunity of getting certificates for their children under the School Attendance Act when they are absent from school through illness. Very often they are unable to get certificates certifying the cause of their absence, and a very shocking injustice is being done to people under the School Attendance Act simply because they are unable to pay for doctors' certificates. They have been frequently fined in the courts. Even prosecution, apart from a fine, is often the cause of the loss of a day's employment. I suggest that the Minister should give that matter consideration.
General MULCAHY: I am afraid it raises an entirely different matter. These matters are really best raised by representations with regard to particular cases or particular areas to myself in this particular matter, or to the Minister for Education.
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